Stress fractures are common overuse injuries in athletes. They typically affect the lower extremity and are most common in the tibia. Runners and track and field athletes are particularly susceptible to stress fractures. Female athletes sustain stress fractures more frequently than their male counterparts. A number of possible risk factors, including anatomic differences, nutritional intake, and hormonal balance, have been identified that may explain this increased injury rate. History and physical examination can often diagnose stress fractures, but scintigraphy or magnetic resonance imaging is frequently obtained to confirm the diagnosis. Stress fractures can be treated nonoperatively in most cases. A treatment program of rest, pain control, and gradual return to activity is usually successful in returning the athlete to their sport. However, stress fractures of the femoral neck, tarsal navicular, anterior cortex of the tibia, and fifth metatarsal will often require surgical stabilization.
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