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

#### Summary points The annual incidence of overuse injuries in track and field athletes is estimated to be 3.9 per 1000 training hours, with a prevalence of 76%,w1 and 10-20% of consultations in sports medicine practice are for stress fractures.1 Stress fractures are also common among army recruits. With the advent of magnetic resonance imaging, stress fractures are diagnosed earlier and more readily than they were in the past, and early surgical treatment is increasingly considered as a management option for patients who are at high risk of fracture non-union. Rapid and accurate diagnosis of stress fractures is important to prevent propagation of the fracture, and early effective treatment may reduce time away from training and participation in sport. Experts think that overtreatment of low risk stress injuries and undertreatment of high risk injuries both occur and lead to unnecessary time away from training.2 In addition, increasing participation of non-athletes in endurance sports such as marathon running has led to an increase in stress injuries among non-professional sportspeople. We review the diagnosis and management of stress injuries of the lower limb, drawing on evidence from randomised trials, non-randomised intervention studies, observational studies, …