D i.e. Stress fracture After a prolonged period of repeated stress (6 month of army recruit) presence of acute onset pain and point tenderness , over posteromedial aspect of both legs (i.e. tibia), with aggravation of pain on physical activity is clearly indicative of stress fracture of tibia. Stress Fracture Predisposing/ Risk- Factors Type Clinical Presentation InvestigationX Ray - Predominant risk factor is an increase in trainingfrequency and intensityQ - Predisposed individuals areatheletes, army recruitsQ, dancers and other spos personsinvolved in basket ball rowing, swimming &throwing etc.- Activity that producerepetitive loadingQ- Leg length discrepancyincreases the risk but therisk is not specific to shoeror longer leg.- Female athlete traid i.e.eating disorder, osteopenia,menstrual disturbance. * Fatigue caused by application ofabnormal muscular stress on normal bone* Insufficiency caused by normalmuscular activity on bone that is deficientin minerals. - Load related pain in athletes withgradual onset over a period ofweeks during training oftenoccuring during the first few weeksafter an increase in training volume orintensity, a change in technique orsurface or an alteration of footwearFor non athletes, a recent atypicalincrease in activity (vacation withwalking or aerobic activities) maybe describedIf left unchecked pain may becomepersistent, pain at rest or evennight painThe hallmark physical finding isfocal bone pain (tenderness) withpalpation & stressingQ Percussionof bone typically produces pain butmotion of adjacent joints does not. Three phase bonescintigraphyIf multiple sites of arepossible or x - ray donot suppo thediagnosis. It is mostsensitive test for stressfracture (- 100%) butnot coupled with highspecificity- MRI provide identicalsensitivity and superiorspecificity compared tobone scintigraphy.C T scans* Treatment issymptomatic with castand cessation ofactivityQ