Fibula stress fractures should be managed with rest from any precipitating activity, physical therapy, and treatment of any contributing factor, whether metabolic, nutritional, postural, or other. Most fractures should uneventfully heal within 6-12 weeks by implementing this strategy. However, certain locations of this injury deserve specific attention as unique static and dynamic factors may be related with fracture pathomechanism in these areas. Proximal fibular area injuries may be related with either direct repetitive pressure applied over the affected area, or muscular forces that increase stress transfer in this area under exceptional exercise conditions. The distal fractures area may be related with specific pathologic functioning of the syndesmotic joint. Although operative intervention for direct fibula stress fracture fixation has never been described in the published studies, for syndesmotic dysfunction, surgical intervention may be necessary to recreate load transfer through this joint to the distal fibula area. Several modalities for healing enhancement of fibula stress fractures have also been described in the literature, and should be thought-of. These modalities include low-intensity ultrasound, pneumatic bracing, and electromagnetic field therapy. However, evidence-based published data to support the usefulness of these modalities in the healing process of this injury is lacking.
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