Stress fracture of the anterior tibial diaphysis is rare and occurs mostly in leaping athletes. Thirty-six of these fractures in 35 patients have been reported in the literature. These are combined with 15 similar fractures in our experience to provide combined data on 51 anterior tibial stress fractures. Comparison of the various treatments utilized disclosed that there is a high risk of complete fracture if affected patients are allowed full activity, and that treatment by rest alone allowed only 40% to return to full activity even after symptomatic improvement. The treatment recommended for these patients is excision of the fissure, transverse drilling at the fissure site, and cancellous bone grafting of the defect. In those patients who suffer a complete fracture, open reduction and internal fixation is superior to closed treatment.