Isolated fibular stress fractures: Radiographic parameters

•Fibular stress fractures are an uncommon phenomenon with few well defined risk factors.•This study found that distal fibular stress fractures are the most common location and most common in women.•Distal fibular stress fractures are more common in hindfoot valgus alignment. This could be due to a greater amount of axial force through the lateral distal tibia and fibula during ambulation. Fibular stress fractures are uncommon injuries with an incompletely understood pathogenesis and predisposing characteristics. This study investigated the demographic and radiographic risk factors for fibular stress fractures. A retrospective chart review from 2010 to 2018 revealed thirteen patients with isolated fibular stress fractures. Demographics, history of fracture, fracture location, bone quality, and heel alignment were collected. The cohort consisted of six men and seven women with a mean age of 41.8 years. The average BMI was 28.5kg/m2. Three patients used tobacco. 69.2% of fractures were in the distal third, 23.1% proximal third, and 7.7% middle third. No patients had evidence of osteopenia. Distal fibula stress fractures were more common in women (66.7%) and associated with hindfoot valgus. Distal third fibula stress fractures were most common and associated with hindfoot valgus. This could be due to a greater amount of axial force through fibula in this alignment. Level IV, Retrospective Case Series.