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

Discussion
An unusual stress fracture of the proximal phalanx of the great toe: A case report
G.C. Pitsis* & J.P. Best Eastern Suburbs Sports Medicine Centre, Sydney, Australia
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.
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