{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:51:31Z","timestamp":1790873491272,"version":"4.1.0"},"reference-count":6,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,8,28]]},"abstract":"<jats:p>We present a case of fibular insufficiency (stress) fracture in a patient with pre-existing asymptomatic advanced tibialis posterior dysfunction. The patient had severe planovalgus (flat foot) deformity but no pain before the injury; hence had never sought any treatment. She was first treated conservatively for the fracture which failed to control the deformity and had ongoing symptoms. She eventually required tibio-talo-calcaneal fusion. To the best of our knowledge, this is the first case report of this condition in the English literature. In patients with severe tibialis posterior dysfunction, weight-bearing axis passes directly from calcaneum to fibula making it vulnerable to fracture. Patients should be made aware of this risk even if they are asymptomatic and encouraged to use orthotic support for protection against insufficiency fractures.<\/jats:p>","DOI":"10.1136\/bcr-2017-221206","type":"journal-article","created":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T15:05:29Z","timestamp":1504796729000},"page":"bcr-2017-221206","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Fibular insufficiency fracture: an under-reported complication of advanced tibialis posterior dysfunction"],"prefix":"10.1136","volume":"2017","author":[{"given":"Suresh","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Pilgrim Hospital, Boston, Lincolnshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-8525","authenticated-orcid":false,"given":"Harish","family":"Kurup","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Pilgrim Hospital, Boston, Lincolnshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,7]]},"reference":[{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.1","first-page":"6303","article-title":"Stress fracture of the distal fibula in flatfoot patients: case report","volume":"8","author":"Cheng","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.2","doi-asserted-by":"crossref","first-page":"e970","DOI":"10.3928\/01477447-20160526-04","article-title":"Acute tibialis posterior tendon rupture with pronation-type ankle fractures","volume":"39","author":"Bernstein","year":"2016","journal-title":"Orthopedics"},{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.3","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/00003086-198404000-00047","article-title":"Role of the fibula in weight-bearing","volume":"184","author":"Takebe","year":"1984","journal-title":"Clin Orthop Relat Res"},{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.4","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/107110070102200312","article-title":"The effects of adult acquired flatfoot deformity on tibiotalar joint contact characteristics","volume":"22","author":"Friedman","year":"2001","journal-title":"Foot Ankle Int"},{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.5","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.2106\/00004623-200211000-00015","article-title":"Talocalcaneal and subfibular impingement in symptomatic flatfoot in adults","volume":"84-A","author":"Malicky","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"2025082700593264000_2017.sep07_1.bcr-2017-221206.6","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/107110070502600806","article-title":"Effects of a UCBL orthosis and a calcaneal osteotomy on tibiotalar contact characteristics in a cadaver flatfoot model","volume":"26","author":"Havenhill","year":"2005","journal-title":"Foot Ankle Int"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221206","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:59:45Z","timestamp":1756281585000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,7]]},"references-count":6,"alternative-id":["10.1136\/bcr-2017-221206"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221206","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,7]]}}}