Malleolar Stress Fracture as the First Manifestation of Undiagnosed Crohn's Disease: A Case Report
Abstract
Introduction: Stress fractures (SFs) typically result from repetitive high-impact activities in athletes or military personnel. Their occurrence in young, non-athletic individuals without significant mechanical overload is uncommon and warrants investigation for underlying systemic conditions. Although Crohn's disease (CD) is associated with increased fracture risk due to chronic inflammation, malabsorption, and nutritional deficiencies, SFs as the initial manifestation of clinically silent CD are rarely documented. To the best of our knowledge, this represents the first reported case of a medial malleolar SF preceding the diagnosis of occult CD. This case is important because it illustrates a SF as a potential sentinel event for hidden inflammatory bowel disease (IBD), prompting orthopedic surgeons to broaden their differential diagnosis in atypical presentations.
Case report: A 28-year-old Caucasian man presented with a 3-week history of progressive medial left ankle pain without trauma or high-impact sports participation. His only relevant activity was repetitive low-intensity bouncing while caring for his infant child. Clinical examination showed localized supramalleolar tenderness, swelling, and an antalgic gait. Magnetic resonance imaging confirmed a medial malleolar SF. In the absence of adequate mechanical overload, further evaluation revealed systemic inflammation, hypoalbuminemia, and micronutrient deficiencies, with normal standard bone metabolism parameters.…
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