Intense start, painful consequences: a case report of fatigue fractures

The aim of this study is to present a case of a patient with stress fractures. Stress fractures, otherwise known as fatigue fractures, result from abnormal and repetitive strain of healthy bone. This leads to micro damages and subsequent fractures. They are most commonly encountered after a sudden and excessive increase in physical activity and most frequently located in the metatarsal, heel, tibia, fibula and femur. This case presents a twenty-nine year old patient, diagnosed with obesity, not involved in sport ever before. Since the end of the spring, he started to exercise intensively at the gym, particularly lifting weights. Since the end of summer, he developed increasingly frequent feet pain, so he reported to an orthopedist. An ultrasound examination of the ankle joints was performed and it did not show any soft tissue damage. Subsequent MR imaging of both ankle joints showed a fatigue fracture: the talus bone of both feet and in the left cuboid bone. Excessive physical effort, especially in patients who have not previously participated in sport, can cause fatigue fractures. The diagnostic procedure should include patient's history, X-ray and ultrasound. Fractures at an early stage may not be visible on X- rays, however an MR examination can reveal bone lesions or a fracture line. In the treatment of stress fractures, modification of activity, use of orthosis, direct cooling, short term use of pain drugs and rehabilitation are usually recommended.