Diagnosis and management of bone stress injuries of the lower limb in athletes

SUMMARY POINTS Stress fractures occur mostly in track and distance runners, athletes who take part in field sports, gymnasts, dancers, and military recruits Consider the diagnosis in sports people with risk factors for bone injury and progressively worsening localised bone pain Women with the "female athlete triad" are especially at risk of bony stress injury Magnetic resonance imaging is the most sensitive and specific imaging modality for diagnosing stress fractures Stress fractures with low risk of non-union can be managed in primary care by modifying sports activity and reducing risk factors Involvement of a specialist is necessary for fractures at high risk of non-union and operative fixation may be considered