PURPOSE: An abrupt increase in duration, intensity, or frequency of physical activity without adequate periods of rest can make patients susceptible to stress fractures, which are typically unilateral and located in the posteromedial tibia diaphysis. METHODS: We present a unique case report of a bilateral proximal epiphysis stress fracture. RESULTS: Here we present a young female patient presenting with bilateral tibia stress fractures after running in a half marathon that she had not trained for. Initial radiographs did not reveal any acute abnormalities, but subsequent MRI demonstrated incomplete stress fractures of the bilateral medial tibial epiphysis. Conservative management including compressive knee sleeves was initiated, with reduced pain reported at the follow-up visit. This patient’s intrinsic risk factors for stress included female gender, while her extrinsic risk factors included poor footwear, improper training, and foot anomalies. Even in the absence of significant intrinsic risk factors, stress fractures should be included on the differential if history reveals recent intense physical exercise. CONCLUSION: History was vital in detecting and treating this patient’s bilateral knee pain. We were fortunate enough to have a clinical suspicion of stress fracture and our patient is progressing towards her baseline.



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