Managing Stress Fractures in Elite Female Gymnasts: Beyond the Obvious Diagnosis

23-year-old female athlete (artistic gymnastics, national A-squad) with persistent symptoms for the past 8 months in the anterior tibial region, which occur after, but not during training (especially on vault and floor exercises). She has repeatedly taken breaks from training for approximately 3 weeks. After that, she resumed training progressively without jumps, but each time this led to a recurrence of pain. Treatment with vitamin D and calcium is ongoing. Currently, she is again reporting pain under load in the area of the right tibia. These symptoms are also present in daily life but improve with rest over a few days. Due to the protracted course, a CT and MRI were performed (2 CT scan images and 1 MRI image, corresponding planes see below). Further questions: – What is the diagnosis? – What other typical locations for such lesions are there? – What are the differential diagnoses (based on the MRI images)? – What additional information do you need in order to manage the case? – How will you manage the case?