Posterior tibial stress fracture: a report of three cases.

OBJECTIVE: To discuss the specific clinical and radiographic features of posterior tibial stress fracture, as well as appropriate clinical management, including imaging and treatment, in the presence of suspected or confirmed tibial stress fracture. CLINICAL FEATURES: Three patients suffered from exercise-related lower leg pain, clinical features, and risk factors specific for posterior tibial stress fracture. Diagnosis was confirmed for all three individuals by radiographic imaging. INTERVENTION AND OUTCOME: Treatment included rest and modified activity, followed by a graded return to activity commensurate with bony healing. This approach was successful for two of the individuals diagnosed with posterior tibial stress fracture. In the third individual treatment recommendations were not adhered to, resulting in three separate stress fractures of the posterior tibia over 27 months.
CONCLUSION: Stress fractures may go undiagnosed for a long period of time; therefore a high index of suspicion, along with knowledge of its clinical and predisposing factors, is necessary for recognition. Inappropriate management of individuals with tibial stress fracture may result in recurrence or frank fracture. Chiropractors have a role in the prevention of stress fractures by identifying and educating patients at risk for this condition.