Stress fracture of the neck of talus in an adolescent female with hypothyroidism: a case report of an unusual cause of ankle pain

Introduction: Stress fractures occur when repetitive, cyclic loading exceeds the bone’s capacity for remodeling. Talar stress fractures are rare, typically affecting the head or body, while involvement of the talar neck remains largely undocumented. Early diagnosis is essential, as even high-risk fractures can be managed successfully with conservative treatment. Case presentation: An 18-year-old hypothyroid female on levothyroxine therapy (37.5 mcg/day), undergoing intense training for military recruitment, presented with persistent anteromedial right ankle pain for 5 months. Examination revealed an antalgic gait and hindfoot tenderness without restriction in ankle motion. While initial radiographs revealed normal findings, magnetic resonance imaging (MRI) confirmed a nondisplaced stress fracture at the talar neck (Kaeding–Miller Grade II). The patient was treated conservatively with 6 weeks of non-weight-bearing immobilization, nonsteroidal anti-inflammatory drugs (NSAIDs), and structured rehabilitation, resulting in complete recovery and return to full activity. Discussion: Talar neck stress fractures are exceptionally rare and pose diagnostic challenges due to non-specific symptoms and often inconclusive radiographs. This case emphasizes the importance of considering metabolic contributors – particularly thyroid dysfunction and levothyroxine therapy – as potential risk factors for stress injury in active females. Early MRI was critical in confirming the diagnosis and guiding appropriate management. Conclusion: This case demonstrates that early identification of a talar neck stress fracture using MRI, combined with prompt conservative management, can lead to full recovery even in high-risk fracture locations. Clinicians should maintain a high index of suspicion in active patients with metabolic risk factors and persistent ankle pain.