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Postoperatively, the patient was treated using the regular evidence-based rehabilitation protocol of 5 weeks of non-weight-bearing and 5 weeks of partial weight-bearing. However, after the confirmed radiological union the patient experienced an acute on chronic stress fracture through the osteotomy line. The fracture was treated with immobilisation and all problems disappeared 16 weeks after the initial presentation of the fracture. The present case highlights the importance of a gradual increase in post-operative activities, even when radiological union has been observed.<\/jats:p>","DOI":"10.1136\/bcr-2024-263474","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T06:35:13Z","timestamp":1737786913000},"page":"e263474","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute on chronic stress fracture after a medial malleolar osteotomy following osteochondral lesion of the talus treatment"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8345-1648","authenticated-orcid":false,"given":"Julian J","family":"Hollander","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The 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