Bilateral distal fibular and tibial stress fractures associated with heavy smoking

An unusual case of simultaneous bilateral stress fractures of the distal tibia and fibula in a 45 year old white woman is described. The onset of symptoms was not associated with a specific episode of trauma, sporting activity, or identifiable inflammatory predisposing cause. Her bone density scan, bone profile, and biochemistry were all normal. Although stress fractures are well recognised, bilateral distal tibial and fibular fractures are particularly rare. A high degree of awareness is required for early diagnosis.