Stress fractures in the foot and ankle of athletes

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors.

The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Description of the evidence collection method

To develop this guideline, the Medline electronic database (1966 to 2012) was consulted via PubMed, as a primary base. The search for evidence came from actual clinical scenarios and used keywords (MeSH terms) grouped in the following syntax: “Stress fractures”, “Foot”, “Ankle”, “Athletes”, “Professional”, “Military recruit”, “Immobilization”, “Physiotherapy”, “Rest”, “Rehabilitation”, “Conventional treatment”, “Surgery treatment”. The articles were selected by orthopedic specialists after critical evaluation of the strength of scientific evidence, and publications of greatest strength were used for recommendation. The guidelines were drawn from group discussion. The entire text was reviewed by a group specializing in evidence-based clinical guidelines.

Grade of recommendation and strength of evidence

  1. Experimental or observational studies of higher consistency.

  2. Experimental or observational studies of lower consistency.

  3. Case reports (non-controlled studies).

  4. Opinions without critical evaluation, based on consensus, physiological studies, or animal models.


The target audience of this guideline includes orthopedists, physiatrists and sports doctors in order to guide the diagnosis and treatment of athletes with stress fractures in the foot and ankle.

Autor / Fonte:Lyj Asano, A Duarte, Aps Silva Revista da Associação Médica Brasileira 2014, 60 (6): 512-7