A 22-year-old female player presents with a four-week history of left lower leg pain. She described this as having come on insidiously and that it has become progressively worse. It is now painful walking and can ache at rest. She has had to stop training due to pain. She was seen initially by her club doctor (about ten days after the onset of pain) who had arranged an x-ray series. She was told that this was normal.
The initial x-ray images were reviewed and were indeed felt to be normal. A repeat x-ray series showed a subtle area of periosteal reaction in the region of the patient’s symptoms. The periosteal bone formation extends over a distance of about 10mm. A diagnosis of a fibular stress reaction was made.
Fibular stress reactions heal predictably with altered loading and time. This patient was treated with education, a short period away from football and cross training. She was able to aqua jog and swim immediately following her diagnosis. As she had pain walking she was given crutches for two weeks and encouraged to weight bear as able. From 4 weeks post-diagnosis she was able to start a walk-jog programme and returned to football seven weeks after her diagnosis.
It is important to remember that x-rays can demonstrate stress fractures well. The injury is less likely to be seen if they are done within 1-2 weeks of the injury. In this sort of situation consider repeating the x-ray imaging prior to committing to more expensive, and less accessible, imaging modalities. It is also important to remember the limitations of x-rays for imaging bone stress. About 50% of stress injuries never demonstrate x-ray changes. In these cases, more sophisticated imaging (generally MRI) is helpful.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.