Stress fractures of the tibia commonly affect the lower third of the bone close to the ankle and usually on the inside.  The tibia is one of the most common bones in the body in which to develop a stress fracture.  The incidence of stress fractures increases where athletes play on firm or unforgiving surfaces.  Development of stress fractures in the tibia is also associated with high volumes of weight bearing exercise.

Diagnosis is made clinically in the presence of local tenderness and difficulty weight bearing.  Xray or further imaging is usually not necessary. 

Treatment of the condition should be determined following a thorough biomechanical assessment and is likely to include a period of rest from sport, usually 4-6 weeks.  Deep tissue therapy of the tibialis posterior, soleus and gastrocnemius muscle groups may also be necessary to treat the underlying causes of the abnormal loading. 

Custom made orthotics may be required in order to change the mechanics of the foot.  This can be determined following full biomechanical assessment.  A graded return to sport as the patient recovers is essential to the successful return to activity.  Patients should not attempt to return to sport until local tenderness is resolved and walking is completely pain free.