Stress Fractures

Worked example: stress fracture of the navicular (the archetypal easily-missed stress fracture — see also easily missed orthopaedic fractures and the navicular red flag in the foot & ankle pain hub).

• Demographics: dancers, previously unfit people starting exercise, athletes running on hard surfaces.
• History: consider in bone pain that isn’t responding promptly to usual measures — vague midfoot pain and swelling.
• Examination: focal bony tenderness; swelling is uncommon.
• Investigations: X-ray is usually normal — SPECT-CT or bone scan shows the abnormality.
• Management: cast immobilisation and non-weight-bearing for 6–8 weeks; ORIF if non-union or cast immobilisation fails.

Other classic stress-fracture sites to keep in mind: metatarsal shafts (“march fracture”), tibial shaft, femoral neck (especially in athletes/ runners — do not miss, risk of displacement), and pars interarticularis (spondylolysis) in adolescent athletes.