Introduction:
What Are Stress Fractures? Stress fractures account for
approximately twenty percent of athletic injuries, with eighty
percent of stress fractures occurring in the lower leg. Stress
fractures in the lower extremity are common injuries among
individuals who participate in endurance, high load-bearing
activities (2). The incidence of these injuries has risen due to
earlier and longer participation in sports (3). Stress fractures
occur when repetitive mechanical load exceeds the biological
capacity of
bone, causing
micro-damage (1). This rate exceeds the rate at which bone can
repair itself, requiring recognition and management of risk factors
(2). The initial stage of bone failure is typically called a stress
reaction. If the repetitive loading continues, the stress reaction
can form into a true stress fracture (3). Furthermore, specific
intrinsic and extrinsic risk factors can make an athlete more
likely to sustain a stress fracture.
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Two forms of
treatment can be implemented when dealing with a stress fracture of
the great toe sesamoid; non-operative and operative. Non-operative
treatment of an acute sesamoid stress fracture requires a period of
immobilization and protected weight bearing. The goal is to manage
weight bearing through the heel for a period of six to eight weeks,
giving the sesamoid bones a chance to heal properly. If a displaced
sesamoid stress fracture is present, it is essential that surgical
intervention is performed. Chronic stress fractures can also be
treated non-operatively. Ideally, the area under the base of the
great toe is protected through the use of an orthotic. The use of
an orthotic can be used in combination with a cushioned insole and
a stiff sole of the shoe. The stiff sole allows for a dispersion of
force away from the base of the great toe. In addition, moderation
of activities will be implemented to prevent excessive loading to
the area
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