Skeletal Radiology

, Volume 34, Issue 7, pp 389–394 | Cite as

Talar body fatigue stress fractures: three cases observed in elite female gymnasts

  • F. Rossi
  • S. Dragoni
Scientific Article



To introduce and emphasize the clinical and radiological findings of three talar body fatigue stress fractures in competitive athletes.

Design and patients

Clinical and radiographic skeletal records of 24,562 athletes taken between 1962 and 2002 were retrospectively reviewed. Among these, 6851 files related to acute foot and ankle injuries or chronic post-traumatic sequelae were found.


There were 925 (3.76%) stress fatigue fractures selected from the whole collection. Among these there were three cases (0.32%) of talar body stress fractures diagnosed in elite female gymnasts 15―17 years old. The negative first radiograph become positive 4–6 weeks later. Scintigraphy was positive at an early stage and consistent for the diagnosis. CT and MRI gave positive results 1–2 weeks after the beginning of symptoms which were always greatly diagnostic.


The sports medicine literature lacks reports of talar body fatigue stress fractures. The poor initial sensitivity of radiography makes it problematic to establish an early diagnosis. A wise combination of scintigraphy, CT and MRI has therefore to be relied upon. Familiarity with this rare location for a stress fracture may prevent delayed diagnosis and long-lasting damage, both of which are important factors in competitive athletes.


Stress fractures in athletes Talar body fatigue stress fractures 


  1. 1.
    Matheson GO, Clement DB, Mckenzie DC, Taunton JE, Lloyd Smith DR, Macintyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987; 1:46–58.Google Scholar
  2. 2.
    Iwamoto J, Takeda T. Stress fractures in athletes: review of 196 cases. J Orthop Sci 2003; 8:273–278CrossRefPubMedGoogle Scholar
  3. 3.
    Steingruber IE, Wolf C, Gruber H. Stress fractures in athletes: review of 196 cases. Radiologe 2002; 8:42:771–777.Google Scholar
  4. 4.
    Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sports Med 1996; 6:85–89.Google Scholar
  5. 5.
    Yale J. A statistical analysis of 3657 consecutive fatigue fractures of the distal lower extremities. J Am Podiatr Assoc 1976; 66:739–748.Google Scholar
  6. 6.
    Schneider RC, Kennedy JC. Sports injuries. Mechanism, prevention and treatment. Baltimore: Williams Wilkins, 1985.Google Scholar
  7. 7.
    McBryde AM. Stress fractures in runners. Clin Sports Med 1985; 4:737–752.PubMedGoogle Scholar
  8. 8.
    Orava S, Puranen J, Ala Ketola G. Stress fractures caused by physical exercise. Acta Orthop Scand 1978; 49:19–27.PubMedGoogle Scholar
  9. 9.
    Boyer DW. The trap shooter’s shoulder: stress fracture of the coracoid process. J Bone Joint Surg Am 1975; 571:862–864.Google Scholar
  10. 10.
    Lord MJ, Kwon Ick HR, Kwang Soon S. Stress fractures of the ribs in golfers. Am J Sports Med 1996; 24:118–122.PubMedGoogle Scholar
  11. 11.
    Karlson KA. Rib stress fractures in elite rowers. Am J Sports Med 1998; 26:516–519.PubMedGoogle Scholar
  12. 12.
    Rossi F, Dragoni S. The prevalence of spondylolysis and spondylolisthesis in symptomatic elite athletes: radiographic findings. Radiography 2001; 7:37–42.CrossRefGoogle Scholar
  13. 13.
    Bennel KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in competitive track and field athletes. A twelve months prospective study. Am J Sports Med 1996; 2:211–217.Google Scholar
  14. 14.
    Van Hal ME, Kene JS, Lange TA, Clancy WG. Stress fractures of the great toe sesamoids. Am J Sports Med 1997; 16:179–196.Google Scholar
  15. 15.
    McBryde AM, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med 1988; 7:51–60.PubMedGoogle Scholar
  16. 16.
    Meyer SA, Saltzman LC, Albright JP. Stress fractures of the foot and leg. Clin Sports Med 1993; 12:395–413.PubMedGoogle Scholar
  17. 17.
    Bennel KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16:179–196.PubMedGoogle Scholar
  18. 18.
    Hontas MJ, Haddad RJ, Schlesinger LC. Conditions of the talus in the runner. Am J Sports Med 1986; 14:586–590.Google Scholar
  19. 19.
    Motto SG. Stress fracture of the talar body. Clin J Sports Med 1996; 6:278–279.Google Scholar
  20. 20.
    Stocker B, Bennet JT. Stress fracture of the talus following reparation of a talocalcaneal coalition. Foot Ankle Int 2001; 22:56–58.PubMedGoogle Scholar
  21. 21.
    McGlone JJ. Stress fractures of the talus. J Am Podiatr Ass 1965; 55:814–817.Google Scholar
  22. 22.
    Umans H, Pavlov H. Insufficiency fracture of the talus: diagnosis with MR imaging. Radiology 1995; 197:439–442.PubMedGoogle Scholar
  23. 23.
    Spitz DJ, Newberg AH. Imaging of stress fractures in the athlete. Radiol Clin North Am 2002; 40:313–331.CrossRefPubMedGoogle Scholar
  24. 24.
    Mink JH, Deutsch AL. Disorders of the foot and ankle. RSNA Category Course in Muscular Radiology 1993:249–264.Google Scholar
  25. 25.
    Brooks AA. Stress fractures of the upper extremity. Clin Sports Med 2001; 20:613–620.PubMedGoogle Scholar
  26. 26.
    Callahan LR. Stress fractures in women. Clin Sports Med 2000; 19:303–314.PubMedGoogle Scholar
  27. 27.
    Walberg JL, Johnson CS. Menstrual function and eating behaviour in female elite athletes. Med Sci Sports Exerc 1991; 23:30–36.PubMedGoogle Scholar
  28. 28.
    Skolnick AA. Female athlete triad: risk for women. JAMA 1993; 270:981–923.Google Scholar
  29. 29.
    Devas M. Ultrasonic assessment of stress fractures. Br Med J 1983; 286:1479–1480.Google Scholar
  30. 30.
    Rupani HD, Holder LE, Espinola DA, Engin SI. Three-phase radionuclide bone imaging in sports medicine. Radiology 1995; 156:187–196.Google Scholar
  31. 31.
    Martire JR, Levinsohn EM. Imaging of athletic injuries. New York: McGraw-Hill, 1992.Google Scholar
  32. 32.
    Murcia M, Brennan RE, Edieken J. Computer tomography of stress fracture. Skeletal Radiol 1982; 8:193–195.CrossRefPubMedGoogle Scholar
  33. 33.
    Somer K, Meurman KOA. Computed tomography of stress fractures. J Comp Assist Tomogr 1982; 6:193–195.Google Scholar
  34. 34.
    Bradshaw C, Khan K, Bruckner PD. Stress fracture of the body of the talus in athletes demonstrate with computed tomography. Clin J Sport Med 1996; 4:278–279.Google Scholar
  35. 35.
    Lee JK, Yao L. Stress fractures: MR imaging. Radiology 1988; 169:217–220.PubMedGoogle Scholar
  36. 36.
    Sijbrandij ES, Van Gils AP, De Lange EE. Overuse and sports related injuries of the ankle and hind foot: MR imaging findings. Eur J Radiol 2002; 43:45–56.CrossRefPubMedGoogle Scholar
  37. 37.
    Daffner HR, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol 1992; 159:245–252.PubMedGoogle Scholar
  38. 38.
    Shereff MJ, Cullivan WT, Johnson KA. Osteoid osteoma of the foot. J Bone Joint Surg Am 1983; 65:638–641.PubMedGoogle Scholar
  39. 39.
    Schiavone Panni A, Maiotti M, Burke J. Osteoid osteoma of the neck of the talus. Am J Sports Med 1989; 17:584–588.PubMedGoogle Scholar
  40. 40.
    Goldman AB, Schneider R, Pavlov H. Osteoid osteoma of the femoral neck: report of four cases evaluated with isotopic bone scanning, CT and MRI. Radiology 1993; 186:227–232.PubMedGoogle Scholar
  41. 41.
    Davies M, Cassar Pullicino VN, Davies AM, McCall JW, Tyrrell PNM. The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol 2002; 31:559–569.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2005

Authors and Affiliations

  1. 1.National Institute of Sports Medicine of the Italian Olympic CommitteeRomeItaly
  2. 2.Istituto Nazionale di Medicina dello Sport RomeItaly

Personalised recommendations