A longitudinal tibial stress fracture

Tibial stress fractures are common in an athletic population. The patient is usually an athlete who is involved in highly repetitive impact activities that have increased in intensity, and who develops pain over the anterior tibia that is felt with exercise and relieved by rest. Physical examination usually reveals focal bony tenderness. Plain roentgenograms initially tend to be normal, and bone scan is the gold standard for diagnosis. Most tibial stress fractures are transverse or oblique. The authors present the first reported case of an activity-related longitudinal stress fracture of the distal tibia in a previously healthy, premenopausal woman. A discussion of this unusual presentation, its radiographic appearance, and its response to treatment is presented.