Lower extremity stress fractures in the military

Stress fractures of the lower extremities are common among the military population and, more specifically, military recruits who partake in basic training. Both intrinsic and extrinsic factors play a role in the development of these injuries, and it is important to identify those individuals at risk early in their military careers. Some of these factors are modifiable, so they may become preventable injuries. It is important to reiterate that one stress fracture places the soldier at risk for future stress fractures; but the first injury should not be reason enough for separation from the military, as literature would support no long-term deficits from properly treated stress fractures. Early in the process, radiographic analysis is typically normal; continued pain may warrant advanced imaging, such as scintigraphy or MRI. Most stress fractures that are caught early are amendable to nonoperative management consisting of a period of immobilization and NWB followed by progressive rehabilitation to preinjury levels. Complete or displaced fractures may require operative intervention as do tension-sided FNSF. Improving dietary and preaccession physical fitness levels may play a role in reducing the incidence of stress fractures in the active-duty military population. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.