Disclosures: Shanterian J. King, DO: No financial relationships or conflicts of interest

Case Diagnosis: Left Distal Fibula Stress Fracture

Case Description or Program Description: RW is a 16-year-old female who presented with 2-month history of left lateral leg with associated left ankle pain that developed during her volleyball season. Prior to evaluation, she discontinued volleyball activities and had an 80% improvement in symptoms. Denied any leg weakness or sleeping difficulties. Pain was worse in morning, with standing, or walking and pain was improved with resting. Prior treatment included blood flow restriction therapy, PT, home exercise program, ice, massage, and ultrasound. Additionally, patient had initiated crutches for 1 week along with a walking boot for treatment purposes prior to evaluation. On physical exam, no abnormalities were noted on inspection, palpation, and strength with a negative hop test and single leg raises. MRI of left leg revealed moderate grade stress reaction (Fredricson Grade I) involving the distal fibula diaphysis through metadiaphysis. Regarding management, advised long leg air cast immobilization, anti-inflammatories for symptom management, and vitamin D and calcium supplementation.

Setting: Quaternary academic medical center

Assessment/Results: At 1 month follow up, RW had improvement in pain and transitioned to work with physical therapy focused on foot strengthening exercises. Thereafter, RW transitioned to passing activities with volleyball and with a gradual return to play as tolerated.

Discussion (relevance): Distal fibular fractures are most commonly seen in running and jumping athletes. Risk factors for fibular stress factors include activity related including excessive training or training on hard terrain, biomechanical factors such as leg length discrepancy, pes planus or cavus feet, and metabolic factors including demineralization secondary to hormonal or nutritional imbalances.

Conclusions: Distal fibula stress fractures should be considered when evaluating jumping and running athletes especially in setting of increased training, altered biomechanics, or hormonal or nutritional imbalances.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/left-leg-pain-in-a-teenage-volleyball-player-a-case-report/