{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:57:07Z","timestamp":1790855827821,"version":"4.1.0"},"reference-count":82,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Musculoskelet Radiol"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Bone stress injuries (BSIs) are a frequent finding in athletes, particularly of the foot and ankle. A BSI is caused by recurring microtrauma to the cortical or trabecular bone exceeding the repair capacity of normal bone. The most frequent fractures at the ankle are low risk, characterized by a low risk for nonunion. These include the posteromedial tibia, the calcaneus, and the metatarsal diaphysis. High-risk stress fractures have a higher risk for nonunion and need more aggressive treatment. Examples are the medial malleolus, navicular bone, and the base of the second and fifth metatarsal bone.<\/jats:p><jats:p>Imaging features depend on the primary involvement of cortical versus trabecular bone. Conventional radiographs may remain normal up to 2 to 3 weeks. For cortical bone, early signs of BSIs are a periosteal reaction or the \u201cgray cortex sign,\u201d followed by cortical thickening and fracture line depiction. In trabecular bone, a sclerotic dense line may be seen. Magnetic resonance imaging enables early detection of BSIs and can differentiate between a stress reaction and a fracture. We review typical anamnestic\/clinical findings, epidemiology and risk factors, imaging characteristics, and findings at typical locations of BSIs at the foot and ankle that may help guide treatment strategy and patient recovery.<\/jats:p>","DOI":"10.1055\/s-0043-1766098","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T22:58:51Z","timestamp":1685055531000},"page":"283-292","source":"Crossref","is-referenced-by-count":7,"title":["Bone Stress Injuries at the Ankle and Foot"],"prefix":"10.1055","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2198-3678","authenticated-orcid":false,"given":"Pia M.","family":"Jungmann","sequence":"additional","affiliation":[{"name":"Musculoskeletal Imaging, Department of Radiology, Kantonsspital Graub\u00fcnden, Chur, Switzerland"},{"name":"Department of Diagnostic and Interventional Radiology, Medical Center\u2013University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6964-4424","authenticated-orcid":false,"given":"Christoph","family":"Schaeffeler","sequence":"additional","affiliation":[{"name":"Musculoskeletal Imaging, Department of Radiology, Kantonsspital Graub\u00fcnden, Chur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1136\/bjsports-2017-098189","article-title":"Epidemiology of imaging-detected bone stress injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics","volume":"52","author":"D Hayashi","year":"2018","journal-title":"Br J Sports Med"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"613","DOI":"10.2214\/ajr.175.3.1750613","article-title":"MR imaging of disorders of the Achilles tendon","volume":"175","author":"M E Schweitzer","year":"2000","journal-title":"AJR Am J Roentgenol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1148\/radiology.134.2.7352236","article-title":"Stress fracture in soldiers: a multifocal bone disorder. 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