An unusual stress fracture of the proximal phalanx of the great toe: A ...

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Figure 2. Radiograph 4 weeks post-diagnosis DISCUSSION: The patient’s stress fracture was unusual as it occurred simply with relatively low levels of stress and normal bone mineral density. In addition, there was no associated hallux valgus, and was not consistent with the previously documented age group of adolescence. Stress fractures are more common in female athletes with menstrual disturbances (7). Alendronate (Fosamax) is used for treatment in osteoporosis. Hormone replacement therapy with Ogen 1.25 mg and Provera 2.5mg may be effective in reducing the negative effects of menstrual disturbances on bone mineral density (8). The addition of calcium in the exercising individual may also promote increase bone mineralisation (9). She is currently being investigated from an endocrinological viewpoint. This case report supports the opinion that stress fractures of the proximal phalanx of the great toe respond well to non weight-bearing rest with graduated return to activity. This has been recorded previously (1,2). In addition, Shiraishi and colleagues (1) found one of the patients proceeded to non-union as a result of continued training. Biomechanical factors need to be addressed appropriately (10). Evidence of clinical union occurred before radiological union at 4 weeks post-injury. This supports current understanding of the temporal relationship of clinical and radiological union. Thus clinical status of the fracture is of paramount importance when assessing progress of union of the fracture. Radiological investigations will confirm fracture position, and document evidence of union after 4 weeks.
Figure 3. Radiograph 8 weeks post-diagnosis REFERENCES: 1. Yokoe K. and Mannoji T. Stress fracture of the proximal phalanx of the great toe: a report of three cases. American Journal of Sports Medicine 1986; 14 (3): 240-242. 2. Shiraishi M, Mizuta H, Kubota K, et al. Stress fracture of the proximal phalanx of the great toe. Foot and Ankle 1993; 14 (1): 28-34. 3. Matsusue Y, Yamamuro T, Nakagawa Y, et al. Stress fracture of the proximal phalanx of the great toe: the case report of a shot-putter. Clinical Journal of Sports Medicine 1992; 2(4): 279-282 4. Brukner P, Bennell K and Matheson G. Stress fractures. Blackwell Science, 2000. pp 183-184. 5. Eisele S and Sammarco G. Fatigue fractures of the foot and ankle in athletes. Journal of Bone and Joint Surgery – American volume 1993 Feb. 75 (2): 290-298. 6. Hershman E and Mailly T. Stress fractures. Clinics in Sports Medicine 1990 Jan. 9 (1): 183-214 7. Brukner P and Bennell K. Stress fractures in female athletes. Diagnosis, management and rehabilitation. Sports Medicine 1997 Dec. 24 (6):419-429 8. Fields C and Fricker P. Medical problems in athletes. Blackwell Science, 1997. 9. Brukner P and Khan K. Clinical sports medicine, second edition. McGraw Hill 2000. 10. Knapp T and Garrett W. Stress fractures: general concepts. Clinics in Sports Medicine 1997 Apr. 16(2): 339-356.
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An unusual stress fracture of the proximal phalanx of the great toe: A ...

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