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Musculoskeletal and Sports Medicine

A Talar Stress Fracture in a Collegiate Runner: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 3
Disclosure(s):
Jerry D. Yue: No financial relationships to disclose
Farah Hussain, MD: No financial relationships to disclose
Victor Owiredu: No financial relationships to disclose
Case Diagnosis: 17-year-old collegiate male runner with a talar stress fracture.

Case Description or Program Description: A 17-year-old collegiate male runner presented with worsening right ankle pain that persisted at rest after rolling his ankle 1 week prior. He had no history of bone stress injuries and was running 60 miles/week. Exam showed lateral ankle swelling and pain with resisted inversion. Strength and range of motion were normal with no bony tenderness or instability. Ankle x-ray was normal. He was diagnosed with a lateral ankle sprain and treated with a walking boot, rest, and ankle rehab. One month later, after resuming running, his symptoms worsened, causing pain while walking and at rest. Magnetic resonance imaging showed a nondisplaced talar neck and body stress fracture with bone marrow edema.

Setting: Outpatient Sports Medicine Clinic

Assessment/Results: After non-weight bearing for 6 weeks using a knee scooter and boot, patient progressed to partial weight bearing with crutches for 2 weeks, then weight bearing as tolerated. Metabolic lab workup was normal and there were no concerns for low energy availability. He completed a return-to-run program and rehabilitation exercises focused on ankle, glute, and hip strengthening, and returned to competitive running after 5 months.

Discussion (relevance): While the tibia is the most common stress fracture site in runners, talar stress fractures are rare with 4.4 cases reported per 10,000 person-years. The talar head is typically affected, followed by the body and posterior. The diagnosis can be challenging as symptoms can be vague; this case highlights the importance of additional diagnostic testing when symptoms do not improve with initial treatment. The talus is a high-risk site; treatment involves 6 weeks of non-weight bearing initially, addressing risk factors, and training programs that reduce repetitive loading, improve mechanics, and strengthen surrounding muscles.

Conclusions: This case highlights the diagnosis and management of a talar stress fracture in a collegiate cross-country runner.