Foot and Ankle Stress Fractures in Athletics

Stress fractures of the foot and ankle in athletes represent a challenging problem for the orthopedic surgeon, as they are associated with high rates of reoccurrence and long-lasting absence from daily sport activities. In elite sports, stress fractures most commonly occur in the lower extremity. In the event of persistent overload (i.e., mechanical forces exceeding physiological forces), the regenerative and reparative capacities of the involved bone are insufficient to manage the resulting microtrauma. Stress fractures can be subdivided into high-risk (tibial malleolus, navicular, sesamoids, and fifth metatarsal) and low-risk (calcaneus, cuneiform, first metatarsal bone, cuboid) stress fractures. Low- risk stress fractures generally have a high healing propensity when treated conservatively, while high-risk fractures often warrant surgical treatment due to poor healing propensity. The aim of this review is to outline the most common stress fractures of the lower extremity and provide specific guidelines for the diagnosis, treatment, and return to sport in the (elite) track and field athlete.