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Stress fractures may occur either due to an extreme muscle strain (fatigue fracture) or a normal strain within the context of pre-existing bone weakness (insufficiency fracture). Stress fractures of the tibia associated with osteoarthritis of the knee have been described in the literature. In osteoarthritic patients with genu varum deformity altered biomechanics lead to further strain on bone. We describe a 68 year-old woman with genu varum deformity due to osteoarthritis of the knee and concomitant osteomalacia due to lack of exposure to sunlight. She was operated on using an expandable intramedullary nail which enabled early mobilization and prevented further complications such as nonunion and sequential fractures.