Bilateral Stress Fractures of the Tibia in a Long-Distance Runner

Posterior tibial stress fractures, which are less common than anterior tibial stress fractures, generally have a favorable outcome for resuming athletic activities. Complete fractures are uncommon. A male athlete, age 21, who competes in long-distance running for college athletics, reported experiencing discomfort during training three weeks prior. He covered up to 300 km a week in a balanced manner on the streets and mountains. Even though he had posterior tibial stress fractures, he continued to run, ignoring the pain in his lower legs. After suffering a right lower leg injury during a session of long-distance running, the athlete was sent to the emergency room a year later. He experienced bilateral tibial stress fractures, one of which was fully developed and the other incomplete, at the same time. This is a case of a rather uncommon situation involving bilateral posterior stress fractures managed surgically by exchange intramedullary nailing. One side had a full fracture while the other had a partial fracture. After surgical procedures, the patient was able to start lightly running three months later and was symptom-free five months later. After a year, he could begin running long-distance again. Compared to anterior tibial stress fractures, posterior tibial cortical fractures seem more prevalent among runners and adapt better to conservative therapy. We suggest that if individuals continue receiving excessive training, close, careful monitoring is required.