Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Sep;46(9):1165-1186.
doi: 10.1007/s00256-017-2632-7. Epub 2017 Mar 25.

Stress Fractures of the Foot and Ankle, Part 2: Site-Specific Etiology, Imaging, and Treatment, and Differential Diagnosis

Affiliations
Review

Stress Fractures of the Foot and Ankle, Part 2: Site-Specific Etiology, Imaging, and Treatment, and Differential Diagnosis

Jacob C Mandell et al. Skeletal Radiol. .

Abstract

Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

Keywords: Fibula; Foot and ankle; Metatarsal; Stress fracture; Stress reaction; Tarsal; Tibia.

Similar articles

  • Stress fractures about the tibia, foot, and ankle.
    Shindle MK, Endo Y, Warren RF, Lane JM, Helfet DL, Schwartz EN, Ellis SJ. Shindle MK, et al. J Am Acad Orthop Surg. 2012 Mar;20(3):167-76. doi: 10.5435/JAAOS-20-03-167. J Am Acad Orthop Surg. 2012. PMID: 22382289 Review.
  • Stress Reaction and Fractures.
    Kiel J, Kaiser K. Kiel J, et al. 2019 Jun 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. StatPearls. 2020 Jan–. PMID: 29939612 Free Books & Documents. Review.
  • Stress fractures of the foot and ankle.
    Welck MJ, Hayes T, Pastides P, Khan W, Rudge B. Welck MJ, et al. Injury. 2017 Aug;48(8):1722-1726. doi: 10.1016/j.injury.2015.06.015. Epub 2015 Sep 15. Injury. 2017. PMID: 26412591 Review.
  • The pathophysiology, diagnosis, and management of foot stress fractures.
    Pegrum J, Dixit V, Padhiar N, Nugent I. Pegrum J, et al. Phys Sportsmed. 2014 Nov;42(4):87-99. doi: 10.3810/psm.2014.11.2095. Phys Sportsmed. 2014. PMID: 25419892 Review.
  • Stress Fractures of the Foot.
    Hossain M, Clutton J, Ridgewell M, Lyons K, Perera A. Hossain M, et al. Clin Sports Med. 2015 Oct;34(4):769-90. doi: 10.1016/j.csm.2015.06.011. Clin Sports Med. 2015. PMID: 26409595 Review.
See all similar articles

Cited by 7 articles

See all "Cited by" articles

References

    1. Injury. 2012 Oct;43(10 ):1626-32 - PubMed
    1. AJR Am J Roentgenol. 1992 Aug;159(2):245-52 - PubMed
    1. Clin Orthop Relat Res. 1981 Jun;(157):82-7 - PubMed
    1. Br Med J. 1955 Jan 29;1(4908):264-5 - PubMed
    1. Injury. 2015 Sep 15;:null - PubMed

LinkOut - more resources

Feedback