Presentation
Runner with distal shin pain.
Patient Data
Small focus of calcified periosteal reaction in the distal fibula. Small well-corticated ossicle at the lateral malleolar tip.
One month later, the patient had increasing pain and a repeat x-ray was performed.
Increased calcified periosteal reaction along the distal fibular shaft with new loss cortical density and complete fracture line.
Case Discussion
Typical changes of initially a stress response/injury progressing to a stress (fatigue) fracture one month later in a patient with the risk factor of long-distance running. The distal fibular is a less common location for stress fractures in the lower limb, when they do occur it is typically at the lateral cortex of the distal-third, as in this case.