Stress Fractures in Sport: Foot

Saxena, Amol; Anderson, Robert B.; Bouché, Richard T.; Fournier, Magali; Fullem, Brian; Gerdesmeyer, Ludger; Maffulli, Nicola

doi:10.1007/978-3-030-72036-0_27

Cited by 1 publication

(6 citation statements)

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“…Similar to acute fractures, with the limited, heterogeneous data available, it remains difficult to conclude the optimal management for sport-related, toe phalanx stress fractures[ 8 , 22 - 26 ]. Anatomically, these should be ‘low-risk’ stress fractures, so conservative management should form the first line of treatment[ 7 , 33 , 34 ]. This has been shown to provide acceptable RRS and RTS[ 8 , 22 - 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…By comparison to acute fractures, the epidemiology of toe phalanx stress fractures is less well described[ 7 ]. While a significant proportion of these fractures are sport-related, the current literature on this injury type comprises a limited number of case series and case reports[ 7 ]. While there are emerging theories that link biomechanical deformities to their occurrence ( e.g.…”

Section: Introductionmentioning

confidence: 99%

“…The most common causative sports for acute toe phalanx fractures are soccer, gymnastics, and judo[ 9 ]. The most common causative sports for stress-toe phalanx fractures are sprinting, soccer and long-distance running[ 7 ]. For acute toe phalanx fractures, the common sporting mechanisms of injury include tackle and dismount[ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Open fractures require fracture site washout +/- fixation[ 9 ]. Stress fractures of the toe phalanx are routinely managed conservatively in the first instance, with protected weight-bearing and avoidance of relevant sporting activities[ 7 ]. However, those with significantly delayed presentation (> 1 year) and established non-union, or those that are associated with a significant causative deformity, often require surgical intervention[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this treatment framework, there is very limited information in the current literature to guide the optimal management of these fractures in the athlete[ 7 , 9 - 11 ]. Similarly, there is very limited published data, which illustrates the expected morbidity that such fractures will have on the athlete[ 7 , 9 - 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Return to sport following toe phalanx fractures: A systematic review

Robertson,

Sinha,

Hodkinson

et al. 2023

World J Orthop

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BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited. AIM To systemically review all studies recording return to sport following toe phalanx fractures (both acute fractures and stress fractures), and to collate information on return rates to sport (RRS) and mean return times (RTS) to the sport. METHODS A systematic search of PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, and Google Scholar was performed in December 2022 using the keywords ‘Toe’, ‘Phalanx’, ‘Fracture’, ‘injury’, ‘athletes’, ‘sports’, ‘non-operative’, ‘conservative’, ‘operative’, ‘return to sport’. All studies which recorded RRS and RTS following toe phalanx fractures were included. RESULTS Thirteen studies were included: one retrospective cohort study and twelve case series. Seven studies reported on acute fractures. Six studies reported on stress fractures. For the acute fractures ( n = 156), 63 were treated with primary conservative management (PCM), 6 with primary surgical management (PSM) (all displaced intra-articular (physeal) fractures of the great toe base of the proximal phalanx), 1 with secondary surgical management (SSM) and 87 did not specify treatment modality. For the stress fractures ( n = 26), 23 were treated with PCM, 3 with PSM, and 6 with SSM. For acute fractures, RRS with PCM ranged from 0 to 100%, and RTS with PCM ranged from 1.2 to 24 wk. For acute fractures, RRS with PSM were all 100%, and RTS with PSM ranged from 12 to 24 wk. One case of an undisplaced intra-articular (physeal) fracture treated conservatively required conversion to SSM on refracture with a return to sport. For stress fractures, RRS with PCM ranged from 0% to 100%, and RTS with PCM ranged from 5 to 10 wk. For stress fractures, RRS with PSM were all 100%, and RTS with surgical management ranged from 10 to 16 wk. Six cases of conservatively-managed stress fractures required conversion to SSM. Two of these cases were associated with a prolonged delay to diagnosis (1 year, 2 years) and four cases with an underlying deformity [hallux valgus ( n = 3), claw toe ( n = 1)]. All six cases returned to the sport after SSM. CONCLUSION The majority of sport-related toe phalanx fractures (acute and stress) are managed conservatively with overall satisfactory RRS and RTS. For acute fractures, surgical management is indicated for displaced, intra-articular (physeal) fractures, which offers satisfactory RRS and RTS. For stress fractures, surgical management is indicated for cases with delayed diagnosis and established non-union at presentation, or with significant underlying deformity: both can expect satisfactory RRS and RTS.

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