Lower limb pain and disability following strenuous activity

One hundred five military recruits were evaluated in our outpatient clinic for pain in the lower limb following prolonged sustained physical effort and strain. Plain x-ray investigations augmented by technetium-99m polyphosphate demonstrated the presence of 80 stress fractures in 52.4% of the patients. None of the patients had any anatomical abnormalities of the lower limbs. Of the stress fractures seen, 82.5% were located in the tibial and femoral diaphyses and 16.2% were in the small bones of the foot. Plain radiography gave false negative results in 87.3% of documented fractures. The remaining 47.6% of these recruits had no evidence of stress fractures. However, 74% of them had various anatomical deformities of the lower limb, mainly of the feet. Correction of these deformities enabled these patients to return to previous strenuous activities of their basic military traning. The pathogenesis of stress fractures is still not understood. However, the development of persistent pain in the lower limb following prolonged sustained intensive physical activity needs further investigation. Anatomical deformities may be associated with development of stress fractures.