Proximal Fibula Stress Fracture In The Last Mile Of A Marathon - Page #1

Author: Russell Camhi, DO, ATC
Co Author #1: Clifford Stark, DO

Patient Presentation:
Patient presented to office one day after completion of the New York City Marathon.

27 year old female presented to office one day following completion of the New York City Marathon. She states that she was pain-free throughout the race until mile 25.9 at which point she felt the onset of severe and sharp pain in the lateral side of the proximal lower leg. She was able to continue weight-bearing and managed to limp to the finish line, but required the assistance of some nearby runners. She was evaluated by the finish line medical team, given crutches as she could not ambulate without pain, and was referred to our office for evaluation. Of note, the patient has a history of a left foot stress fracture (she did not recall which bone) three years prior to this injury which occurred while training for a marathon.

Physical Exam:
The patient ambulated into the room with crutches. She had swelling of the left lower leg, greater in the proximal portion than distal, without ecchymoses, erythema, or deformity. She was tender to palpation of the proximal fibular head, and had significant tenderness to light touch of lateral lower leg just distal to fibular head and extending distally 3-4cm. She had no tenderness over the tibia, distal fibula, lateral malleolus, or medial malleolus. Range of motion testing revealed that active and resisted dorsiflexion and eversion reproduced proximal-lateral leg pain. There was no pain with inversion or plantarflexion of the ankle. The neurovascular exam was normal throughout the lower extremity.

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