Changes in stress fracture distribution and current treatment

Stress fractures were originally recognized as a problem in the military. As more people undertake strenuous training, the distribution of stress fractures has changed. Some of the difficulties in the discussion of stress fractures are the lack of a consistent definition and the variable sensitivity and specificity of different radiographic techniques. The definition proposed here involves the development of clinical symptoms with a corresponding radiographic change. A high index of suspicion must be maintained to pursue the diagnosis; plain radiographs are often initially negative and may never show characteristic changes. For treatment purposes, stress fractures can be grouped into high-risk and low-risk groups. Low-risk groups can be treated similarly and usually with excellent results, whereas high-risk stress fractures require a more cautious and specific approach.