Stress Fracture Of Fibula Research Articles

Stress Fracture of the Proximal Fibula in Military Recruits

BackgroundWe wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture.MethodsBetween April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs.ResultsTwelve recruits of 635 recruits who complained leg pain were diagnosed as having fibular stress fracture. Eleven cases (10 recruits) appeared at the junction of the proximal and middle 1/3 of the fibula and 2 cases (2 recruits) were in the middle 1/3 of the fibula, as assessed radiologically. Tenderness was the most reliable clinical manifestation. All the fractures occurred after repetitive walking or jumping in a squatting position. Conservative treatments that included bed rest, immobilization and non-steroidal anti-inflammatory drugs administration according to the symptom severity were satisfactory.ConclusionsProximal fibular stress fracture is not rare in military recruits. The shearing force on the proximal fibula and the repetitive stress by walking or jumping in a squatting position contribute to the stress fracture of the proximal fibula.

Bilateral Stress Fractures of the Distal Fibula in a Woman with Osteoporosis

Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain.

Total Knee Arthroplasty for Arthritic Knees with Tibiofibular Stress Fractures: Classification and Treatment Guidelines

Forty-two tibial and 5 fibular stress fractures in 34 patients with knee arthritis were radiologically classified into intraarticular malunited and ununited fractures, and extraarticular impending, acute, united, malunited, and ununited fractures. Depending on fracture type, total knee arthroplasty was performed using long-stem tibial component, metal augments, corrective osteotomy, or in routine fashion. At a mean follow-up of 36 months, the mean Knee Society knee score improved from 36.7 points preoperatively to 90.3 points; function score improved from 24 to 86.2 points. All fractures had united at the last follow-up with no complications of infection, joint instability, and patellar problems. Total knee arthroplasty for knee arthritis in the presence of tibiofibular stress fractures restores limb alignment and facilitates fracture healing with excellent functional outcome.

Isolated Congenital Pseudoarthrosis of the Fibula

Isolated congenital pseudoarthrosis of the fibula is associated with progressive ankle valgus and rare subsequent tibial involvement. Two operative techniques were compared: (1) osteosynthesis with intercalary grafting and (2) distal tibiofibular synostosis. Hemiepiphysiodesis or osteotomy supplemented the primary procedure when necessary. A retrospective review of isolated congenital pseudoarthrosis of the fibula-Dooley types 2 (without ankle valgus) and 3 (with ankle valgus); cases with tibial involvement (Dooley types 1 and 4) were excluded. Nine patients were identified (mean age, 7.6 years, follow-up, 6.6 years). One is under observation without bracing (type 2). Five patients (one type 2 and four type 3) were treated with osteosynthesis. Three were treated with distal tibiofibular synostosis (one type 2 and two type 3). One patient in each group also underwent concomitant medial distal tibia hemiepiphysiodesis; 1 patient in the synostosis group underwent distal tibia varus osteotomy with the primary procedure. In the osteosynthesis group (5 patients), mean lateral distal tibial angle (LDTA) improved from 75.6 to 86.6 degrees. Union was achieved in 4; 1 had early graft resorption requiring revision. Four of the 5 had neutral ankle alignment at the final follow-up. Among the 3 patients with primary union and no deformity correction, mean LDTA improved from 81 to 88 degrees over 9.8 years of follow-up. One patient had mild residual valgus (LDTA, 79 degrees) after temporary screw hemiepiphysiodesis. Complications were as follows: nonunion (n = 1), compartment syndrome with mild residual plantar flexion weakness (n = 1), and fibular stress fracture, which healed with immobilization (n = 1).In the synostosis group (3 patients), the mean LDTA improved from 64.3 to 80.0 degrees. One achieved union with distal tibia medial hemiepiphysiodesis (final LDTA, 86 degrees). Two had failure: one synostosis nonunion underwent repeat varus osteotomy (final LDTA, 81 degrees), and the other (Dooley type 2) had crossunion; however, persistent fibular pseudoarthrosis proximal and distal to the synostosis, progressive valgus developed (final LDTA, 73 degrees). Osteosynthesis with intercalary grafting achieved primary union in 4 of 5 patients; mild residual ankle valgus was present in 1 patient at final follow-up. Synostosis failure with residual ankle valgus at maturity occurred in 2 of 3 patients. Progression to tibial pseudoarthrosis was not observed in either group. In this series, osteosynthesis eliminated fibular discontinuity, allowing correction of ankle valgus. Level III, retrospective comparative study.

Coeliac disease presenting with bilateral fibular stress fractures

We present the case of an apparently healthy 22-year-old female who presented with atraumatic stress fractures of both fibulae. Further investigation demonstrated that she had osteopoenia secondary to occult coeliac disease. The fractures were successfully treated non-operatively. The awareness of the prevalence of occult coeliac disease is increasing due to simpler diagnostic tests, as is its significance as a cause of secondary osteoporosis. Knowing the relationship between these two conditions will help orthopaedic surgeons treating such patients to refer them promptly to appropriate specialists.

Bilateral fibular stress fracture in young female basketball player

This report is a unique case of three stress fractures in a 14-year-old active female basketball player and we emphasize the importance of triple-phase bone scanning in differential diagnosis of the stress fracture. According to radiographic examination and laboratory tests, which were normal, the stress fracture of the right fibula was strongly suspected while making the diagnosis. Despite the treatment applied, recurrence, and deterioration of the symptoms were presented. Repeated laboratory test results were again normal, but the presence of an abundant periosteal reaction on the plain radiographs was confusing, so osteomyelitis or Ewing sarcoma of the fibula was suspected. We decided to perform a three-phase bone scanning; its findings were critical for the judgment and we diagnosed three stress fractures involving both fibulae. Final confirmation of the diagnosis of the bilateral fibular stress fractures in our case, however, was done by computed tomography examination.

Pediatric Unilateral Lower Leg Pain - Cross Country

HISTORY: A 13 year-old male presented with gradually worsening unilateral lower leg pain for 3 weeks. Pain was located on the right, slightly distal and lateral to the knee. Pain worsened with running and pivoting activities, and eventually walking caused pain. He became a member of the cross country team with no distance running prior to the season's start, but does play basketball. Pain began 1-2 weeks after the start of cross country. He denied the following: specific injury, knee complaints, fevers, numbness, tingling, and weakness. Family history is negative for bone and musculoskeletal problems. PHYSICAL EXAMINATION: Exam revealed a well appearing thin male with a normal gait. No bruising, effusion, or swelling at or around the knee. There was tenderness to palpation over proximal right fibula. Knee exam revealed no tenderness, normal testing of ligaments, special tests, and patella. Examination of the hip, foot/ ankle, distal strength, sensation, and pulses were all normal. DIFFERENTIAL DIAGNOSIS: Proximal fibular stress fracture Peroneal muscle strain Iliotibial band syndrome Tumor TESTS AND RESULTS: Tibia/Fibula Radiographs, 2 Views: - open growth plates and vague sclerosis of proximal diaphysis of the fibula, without distinct fracture line. MRI of tibia/fibula was obtained at 2 week follow-up: -complete nondisplaced transverse fracture of the proximal fibula with reactive marrow edema and periosteal reaction. FINAL WORKING DIAGNOSIS: Proximal fibular stress fracture. TREATMENT AND OUTCOMES: Originally treated with avoiding any painful activities. At 2 week follow-up pain was worse and present with any weight bearing. Treatment of strict non-weight bearing with cast boot for 2 weeks was instituted, followed by gradually increasing weight bearing and activity. Follow-up at 4 weeks showed a palpable bony callus of the proximal fibula. No pain with walking, so cast boot was removed and activity was advanced. Repeat radiographs showed healing callus without displacement. 7 weeks after original visit, he was pain free and had returned to running without recurrence of pain.

Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee

Background:Segmental resection of bone in Giant Cell Tumor (GCT) around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered.Materials and Methods:Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven) of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years).Resection arthrodesis with telescoping (shortening) over intramedullary nail (n=5), resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail (n=3) and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening (n=5) were the procedure performed.Results:Shortening was the major problem following resection arthrodesis with telescoping (shortening) over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure.After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (∼15cm) was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm) and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an ilizarov fixator. The complications were superficial infection (n=5), stress fracture of fibula (n=2). The stress fracture fibula required DCP fixation and bone grafting. The usual time taken for union and limb length equalization was approximately one year.Conclusion:Resection arthrodesis with intercalary dual fibular autograft and cortico-cancellous bone grafting with simultaneous limb lengthening achieved limb length equalization with relatively short morbidity.

Bilateral Hip Pain in a Female Adolescent Runner

HISTORY: Sixteen year old female runner presents with 4 months of right hip pain and 2 months of left hip pain. the right hip pain began gradually during track season. She was a distance runner, but no specific trauma or injury. The right hip pain was treated initially with stetching exercise which helped some. In the last 2 months, she has also developed left hip pain. This pain had a gradual onset with no known truama or injury. This pain has gradually gotten worse until she is now unable to run at all without pain. She quit running 10 days ago with some improvement. She gets ocassional painless popping over the right greater trochanter, but no clicking, locking or giving out of either hip. She has a history of right fibular stress fracture. She has been diagnosed with hyperthyroidism due to Grave's disease. Menstrual cycles have been regular for several months. Her nutrition and body image are both normal. PHYSICAL EXAMINATION:General: Cheerful, slight female. Vital Signs: Stable, height in 50th percentile, weight in the 25th percentile. Low Back: Non-tender, no defomity, and no step-off. Range of motion full. Sacrum tender to palpation and compression. Mildly tender over the SI joints left and right. No obvious deformity. Right Hip: Localized pain over the posterior greater trochanter. No deformity. Pain with resisted internal and external rotation of the hip. Mild pain with resisted hip flexion. Postive Thomas test and fulcrum. Otherwise stable and full strength and range of motion. Patricks test negative. Left Hip: pain over the hip flexors but no deformity. Positive Thomas test. Minimal pain with fulcrum test. Otherwise stable hip with full motion and strength. Patricks negative. DIFFERENTIAL DIAGNOSIS: Bilateral hip strain, right hip flexor and short rotators, left hip flexor Hip bursitis Stress fracture neck of the femur Legg-Calve-Perthes disease Juvenile Rheumatoid Arthritis Osteosarcoma TEST AND RESULTS: Xray: Right hip normal, Left hip normal MRI: Hip, Pelvis, Sacrum shows inflammation and tendonosis fo the left and right iliopsoas muscles. Abnormal signal in posterior sacrum left greater than right. Probable stress fracture of the sacrum. FINAL WORKING DIAGNOSIS: 1. Bilateral hip flexor strtain. 2. Stress reaction of the sacrum. TREATMENT AND OUTCOMES: Out of running for 3 months. Physical therapy for stretching and strenghtening program. Repeat xray at 3 months. Gradual return to running.

Diagnostic Imaging and Differential Diagnosis in 2 Case Reports

Retrospective resident's case reports. In today's healthcare setting, it is important for physical therapists to recognize when diagnostic imaging is necessary--as well as know how to interpret the results of these tests--to assist in the clinical decision-making process. Two cases are presented that illustrate how a physical therapist, credentialed to request and review diagnostic imaging, effectively and efficiently utilized multiple forms of diagnostic imaging to assist in his differential diagnosis and clinical decision making. The first case report describes the differential diagnostic process for a 33-year-old active duty military paratrooper who had sustained trauma to his neck. His history was consistent with a C6 radiculopathy, which was confirmed by a neurological screening examination. Radiographs requested by the physical therapist revealed an anterolithesis of C5 on C6, with a possible fracture. An orthopedic surgeon was consulted and further diagnostic testing via magnetic resonance imaging revealed a large disc herniation at C5-6, with spinal cord compression, as well as a C5 vertebral body fracture with nearly perched facets at C5 on C6. The patient was subsequently referred to a neurosurgeon and underwent an emergency C5-6 fusion that afternoon. The second case report describes the differential diagnosis of a 20-year-old active-duty soldier referred for rehabilitation with a diagnosis of a distal fibula stress fracture. Previous treatment by the referring provider included 3 months of rest and anti-inflammatory medications. Physical examination of the patient revealed a marked decrease in ankle inversion with a firm end feel. This was not consistent with the diagnosis established by the referring provider. Subsequent radiographs requested by the physical therapist and a computed tomography scan requested by a podiatrist revealed synostosis of the middle facet of the talocalcaneal joint with an apparent fracture line. The patient subsequently underwent a subtalar arthrodesis. In these cases the physical therapist requested imaging needed for appropriate management, despite the patient having previously seen a primary care provider. In both examples, the physical therapist successfully identified abnormalities prior to a radiologist or other physician reviewing the results. This avoided delay in definitive management of the patients' problems. It is imperative that physical therapists understand when diagnostic imaging is necessary to assist in the differential diagnosis of patients. Likewise, it is important for physical therapists to be competent in interpreting the results of these tests. When not in a direct access physical therapy environment, a physical therapist should understand when diagnostic imaging tests are indicated. This facilitates working with the entire health care team to acquire necessary tests in an appropriate timeframe.

Bilateral distal fibula stress fractures in a young child

Bilateral distal fibula stress fractures in a young child

Bilateral distal fibular stress fractures

Bilateral stress fractures of fibula are very uncommon. We report an unusual case of bilateral stress fractures involving the distal fibula in a middle aged woman following a charity run. Conservative treatment was followed by rehabilitation. The patient made good recovery with no evidence of osteoporosis or recurrence.

Fibula Stress Fracture and Confounding Myositis Ossificans

AbstractA 26-year-old man presented with left lower leg pain after a skiing injury. Plain radiography was initially reported as normal at the site of the suspected fracture but revised after the bone scan. An additional area of calcification was described adjacent to the proximal fibula without a co

Exercise Induced Leg Pain ??? Soccer

0628 HISTORY: A 21 year old female collegiate soccer player presents with a 2-year history of bilateral lower leg pain and cramping with exertion. Symptoms include paresthesias, weakness, swelling, and nighttime symptoms. She has seen a neurologist and an orthopedist with an extensive workup. Initially a bone scan revealed periostitis, treated with activity modification and orthotics. Compartment testing of her right deep posterior compartment measured 25mm of mercury at rest, 50mm post exercise, and 35mm 20 minutes post exercise. She underwent bilateral fasciotomies via a lateral approach with normal post-op compartment testing without relief of symptoms. She had a normal MRI of the L/S spine with and without dye, a normal MRI of both calves, and another bone scan which showed a right fibular stress fracture that resolved clinically. An EMG revealed chronic radiculopathy at L5 and S1. MRA of the aortailiac arteries, venous duplexes of both calves, and MRI of the C-spine were all normal. Medications, including non-steroidals, nortriptyline, metaxalone, gabapentin and quinine were tried without relief. Serology testing was normal. Entering her senior year with symptoms continuing to curtail play despite surgery, orthotics, taping, and stretching, she was referred to our office. PHYSICAL EXAMINATION: Non-antalgic gait. Over pronation bilaterally. Equal leg lengths. Tender along the posterior medial edge of the tibia bilaterally, otherwise non-tender throughout. No effusion, edema, or erythema. Normal neurovascular exam. Complete back, hip, knee and ankle exam all negative. DIFFERENTIAL DIAGNOSIS: Exertional deep compartment syndrome Post operative adhesions Periostitis Stress fracture Neuropathy Vascular entrapment Nerve entrapment Myofascial pain TEST AND RESULTS: None FINAL/WORKING DIAGNOSIS: Exertional deep compartment syndrome not adequately released TREATMENT AND OUTCOMES: Having had success with myofascial release for similar symptomatology, the athlete was sent to Physical Therapy (PT). After 8 sessions of myofascial release, she progressed from running with pain to running 3 miles pain free 4 times per week. She had no neurological symptoms, cramping, or nighttime symptoms. She was released from PT and began her season symptom free. Six weeks out of therapy, she began to experience cramping pain with exertion, and returned for 2 sessions of myofascial release. Again she returned to play symptom free. She continued to receive 1 treatment every 2 weeks for the remainder of the season, enabling her to remain symptom free. No playing time was missed.

Fibular stress fracture after jumping barefoot

A 54-year-old woman was affected by left fibular stress fracture after she started a gym course where she jumped barefoot. The pathology was misdiagnosed as frequently occurs in cases of stress fractures. This pathology must be suspected, also in nonathletic people, in cases of increased physical activity especially in post-menopausal women. Shoes are a risk factor, and barefoot jumping on hard surfaces must be avoided for preventing this kind of fracture. The prognosis is good (4–8 weeks) when the stress fracture is diagnosed correctly and promptly treated, while delayed diagnosis may interfere with the healing process and result in chronic consequences.

Tibial and proximal fibular stress fracture in a rower.

Proximal fibular stress fractures are rare injuries that usually result from jumping and running activities of military recruits and athletes. This article describes a female university athlete with proximal lateral leg pain diagnosed by means of a triphase bone scan as proximal fibular stress fracture and proximal to middle one-third tibial stress fracture. This case highlights the need to examine not only the sport but also the athlete's training habits to identify possible factors contributing to the injury. Body type, biomechanics, and gender are also possible etiologic factors.

PROGRESSIVE KNEE PAIN IN A COLLEGE SOCCER PLAYER

HISTORY AND PHYSICAL EXAMINATION 19-year-old female college student member of the soccer team presents to the school training room with a four-day history of persistent left knee pain. The symptoms began after a practice session during which our athlete perceived a pop and a possible twist to her left knee when running for a ball on a midly inclined and uneven surface. She continued playing and practicing regularly despite intermittent pain localized to the lateral aspect of her left knee. Was evaluated by the trainer and the team physicians at the college training room four days after the incident. The physical exam at that time revealed a normal knee without evidence of edema or effusion, with normal ligamentous stability and tenderness over the lateral aspect not localized to the joint line. McMurray's test was negative and the Ober's test demonstrated some tightness of the ITB compared to the right leg. Stretching, icing and regular analgesics were recommended under the presuntive diagnosis of ITB syndrome. During the following week she continued practicing with increased symptoms, still localized to the lateral aspect of the knee. A new evaluation in the training room only added to the previous findings a more localized tenderness over the central portion of her lateral knee involving the head of the fibula and a McMurray's test positive for pain localizing to the lateral compartment. This new evaluation included fibular stress fracture, lateral meniscal tear and a remmote posibility of OCD in the differential. X-rays were ordered, activity as tolerated was recommended as well as to continue with the stretching rehabilitation program, icing and analgesics. A third evaluation, one week later, revealed similar findings but the symptoms worsen despite the almost total inactivity. An MRI was ordered and no weight bearing activity recommended until the MRI results were available. DIFFERENTIAL DIAGNOSIS Ilio-tibial band syndrome, Tensor fascia lata strain, Fibular stress fracture, Lateral collateral ligament sprain, Lateral meniscal tear, Osteochondritis dissecans. TESTS AND RESULTS X-rays: read as normal. MRI: a 12×12 mm defect involving the lateral aspect of the medial femoral condyle consistent with osteochondritis dissecans. FINAL WORKING DIGNOSIS AND TREATMENT Osteochondritis dissecans (OCD) conformed by MRI. The athlete was referred to a local orthopaedic surgeon. She will undergo surgery during the first week of November, the two surgical possibilities were fixation screw and revarcularization holes. OCD within the condylar epiphyses of the femur involves the lateral aspect of the medial femoral condyle in 75% of the cases and can lead to a variety of non-specific symptoms that usually worsen with weightbearing. These may deviate or delay its diagnosis. A high level of suspicion and awareness is important for accurate diagnosis and treatment including the use of MRI or CT when the typical lesion is not identified in plain X-ray films.

Triple arthrodesis in adults using rigid internal fixation: an assessment of outcome.

The intermediate outcome of patients who underwent a triple arthrodesis for the treatment of adult foot disorders was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 63 feet in 57 patients who underwent a triple arthrodesis using rigid internal fixation for the treatment of hindfoot deformities associated with symptomatic arthrosis. Twenty-four men and thirty-three women, with an average age of 54 years, were evaluated. The average follow-up was 30 months. Multiple diagnoses contributed to hindfoot deformities with secondary arthrosis. Iliac crest bone graft was used in 56 of 63 cases (89%). Percutaneous heel cord lengthening was done in 53 of 63 cases (84%). Twenty-four of the thirty patients (80%) returned to work. Twenty-five patients were retired and two were unemployed before surgery. All patients except two (97%) were satisfied with the surgery and would have the surgery again. The average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot preoperative score was 28 points, and the average postoperative score was 81 points (P < 0.0001). In the radiographic measurements, there was an average improvement of 12 degrees in the lateral talometatarsal angle, 7 degrees in the lateral talocalcaneal angle, and 10 degrees in the AP talometatarsal angle (P < 0.0001). Complications experienced included two varus malunions, two valgus malunions, two nonunions, two deep vein thromboses, one distal fibula stress fracture, and one wound infection. Of the 26 feet in 22 patients with mortise views available, 10 feet (38%) had evidence of ankle arthrosis and 19 feet (73%) had some degree of talar tilt postoperatively.

STRUCTURE, MECHANICS AND INJURIES IN IDENTICAL TWIN RUNNERS: A CASE STUDY.

1458 The purpose of this study was to compare the structure, mechanics and injury patterns of two 22 year-old identical twin male runners. Both subjects were competitive triathletes who typically ran 15 miles per week on average. Each had a history of bilateral pain along the medial borders of the tibiae, right fibular stress fractures and iliotibial band (ITB) syndrome. The subjects were previously given standard orthotics that did not alleviate their symptoms. Each was then given 25° inverted orthotics to which they responded well. Posturally, both subjects exhibited genuvarum, wide-based stance, and midfoot pronation. A structural assessment revealed mild rearfoot varum, forefoot varum, tibial varum and tight ITB in both subjects. The similarities in structure and injury patterns led to an investigation of their three-dimensional mechanics during running. Both subjects were forefoot strikers, exhibiting mechanics characteristic of this foot strike pattern. This pattern has been reported to be related to the anterior tibialis pain both runners experienced. Both subjects exhibited an excessive initial medial ground reaction force suggesting a laterally directed force which might place abnormal stresses on the fibula. Finally, because both subjects exhibited increased tibial internal rotation late into the stance phase, increased stress may have been placed on the ITB as the knee was attempting to extend. Additional studies of identical twins may lend further insight into the relationship between structure, mechanics and injury.

LEG PAIN: FOOTBALL 173

HISTORY - A healthy, twenty year old football player presented with complaints of bilateral leg pain during “two-a-day” fall practices. The pain began insidiously while training two months previously with no trauma. The pain initially occurred after running but now interfered with all drills. He had no paresthesia, weakness, hip pain or back pain. The pain was diffuse but primarily lateral and posterior in his mid-calf. Initial treatment with ice and NSAID's was unsuccessful and he had to discontinue participation. PHYSICAL EXAMINATION - The patient could walk without a limp and had no deformity or swelling. Walking on his toes aggravated his pain. He was entirely neurologically intact to sensory, motor and reflex testing. His compartments were soft but he was tender over the mid-portion of his lateral compartment near the fibula in both legs. He had no ankle swelling or tenderness. He had no pes planus or foot abnormalities. DIFFERENTIAL DIAGNOSIS: Bilateral compartment syndrome Bilateral stress reaction or fracture Gastrocnemius cramps or strains TEST AND RESULTS: Plain radiographs tibia-fibula: normal Three phase bone scan: bilateral mid-shaft fibula stress fracture FINAL DIAGNOSIS: Bilateral mid-shaft fibula stress fracture TREATMENT: Weight bearing as tolerated-no running. Aerobic training with cycling, pool running. Return to football six weeks later.