Only 10 reports of proximal fibula stress fracture in athletes were found at the time the literature search was performed for this article. However, there have been numerous reports of fatigue fracture in the military [11,12]. Fibular injuries were associated with repetitive jumping and subsequent landing in parachute school recruits. The incidence of fibular stress fractures in athletes has not been reported.
Biomechanical studies have shown that the fibula receives between 6.4% and 16.7% of the load transmitted from the lower extremity. The relative decrease in load assumed by the fibula likely accounts for the rarity of this entity. The position of the foot and ankle when the foot is in contact with ground determines the force transmitted. With the foot in an inverted, plantar-flexed position, the load to the fibula is diminished. However, with the foot in an everted, dorsi-flexed position, increased force is transmitted to the fibula. Repeated forceful contraction of the soleus and biceps femoris while the fibula is loaded with the foot in forced dorsiflexion has been postulated as the mechanism that causes fatigue fractures of the proximal fibula [13-15].
Similar to the tibia, diagnosis is predicated on a medical history and physical examination. Plain radiographs, bone scannning, and MRI are useful confirmatory adjunct studies. Although bone scanning is sensitive, MRI has a greater specificity for stress fracture . The value of MRI is its ability to differentiate between stress fracture and sarcoma. Once the diagnosis of proximal fibular stress fracture is obtained, conservative treatment is undertaken.
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