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Discussion on the causes of stress reactions and/or stress fractures is at present under way. There are some pointers indicating that in women athletes this type of sports injury or damage is promoted by hormonal imbalance. Nevertheless, sports practice should always bear in mind that taking the "pill" cannot prevent stress damage. The primary cause is forced mechanical strain or load combined with improperly balanced training. The author makes specific reference to potentially dangerous types of training, and discusses these.

The early exclusion of the presence of a stress fracture may be decisive for the success of an athlete. Scintigraphy with a bone-seeking radiopharmaceutical is suitable for the early detection of stress lesions. Of 30 athletes, fractures were demonstrated in 17 whereas in 6 they were excluded. We found most fractures in the tarsal bones such as os naviculare pedis, ossa cuneiformia and talus. The type of sport engaged in appears to be an important factor in determining the location of the fracture. Scintiphotos were taken in several views using region of interest techniques and two phase-scintigraphy. This method is considered to be useful for localization and follow-up of skeletal stress lesions as well as for differential diagnosis.

Originally, the aim and purpose of performance diagnostics in sports were mainly analysed and defined by researchers in sports medicine, training, performance physiologists and internistic specialists in sports medicine. Meanwhile this term has been overused by almost all groups connected with sports in some way or another, to such a degree that scientific standards and the serious purpose of the problem are completely missed. By no means will every testing method connected with sports and sports performance in a very general sense automatically meet the demands that must be made on performance diagnosis. In orthopaedics and sports traumatology, performance diagnosis has neither been set up nor has it been defined in any way. This article is meant to stimulate interest in the problem in these fields as well.

A stress fracture atypical lesion caused by overstraining the bony skeleton could result in a long-term rest in training. Depending on the type of stress, the localisation changes. The lower extremities are without doubt afflicted most frequently. Complaints, findings and x-ray findings may be unspecific. This complicates the diagnosis in the same way as stress fractures with rare localisation. The concept "stress fracture" is often misleading and should preferably be replaced by "stress reaction". This applies particularly to non-typical radiological patterns. Diagnosis, differential diagnosis and therapeutical aspects are discussed.

Stress fractures of the navicular bone are considered rare. Therefore, the authors report on 29 cases treated during the last 3 years, which must be defined as sports injuries and occurred primarily among women athletes (68%). In view of the different symptoms and duration of the course a differentiated diagnostic and therapeutic approach is required; this is illustrated with reference to the author's experience with 35 cases.