Stress Fractures of the Foot

Chronic foot and ankle injuries are relatively common and are associated with numerous patient and clinical impairments. Proper rehabilitation and treatment techniques are imperative to restore impairments associated with chronic injuries to promote long-term health of the involved tissue(s). However, owing to the complex and multi-faceted mechanism by which chronic injuries develop, implementing effective treatment strategies can be challenging. An impairment-based rehabilitation model has been described and supported within the literature to address factors contributing to injuries. Therefore, the primary purpose of this chapter is to describe common pathways that lead to chronic injury, provide an overview of the most common foot and ankle chronic conditions, and to provide treatment and rehabilitation strategies to restore impairments associated with the injury. First, a theoretical framework is presented to describe pathways that lead to the development of chronic injuries. Next, associated risk factors, pathomechanics, and general characteristics of several chronic injuries are outlined. Finally, strategies to improve patient and clinical impairments of these pathologies are described along with general recommendations for treatment according to an impairment-based rehabilitation model.

Adolescent athletes are a high-risk population for stress fractures. We report four cases of stress fractures of the second proximal phalanx, which had not been previously diagnosed as the location of the stress fracture of the foot, in teenage athletes.

All fractures were on the plantar side of the proximal phalangeal base, and the oblique images of the plain radiograph clearly depicted the fractures. Notably, three out of the four patients had histories of stress fracture of other locations. While three athletes with acute cases were able to make an early return to play with simple conservative management, the chronic case required surgical treatment for this rare injury.

Although a rare injury, it is important that clinicians be aware of this type of stress fracture, as a timely diagnosis can avoid the need for surgical treatment and allow an early return to play.

Les fractures de fatigue représentent un risque important de modification de la posture et de la biomécanique de l’individu. Les connaissances concernant le diagnostic, les facteurs favorisants et les évolutions possibles sont indispensables au thérapeute afin d’adapter au mieux la prise en charge et de limiter au minimum les répercussions.

Stress fractures represent a significant risk of a modification of the individual's posture and biomechanics. It is essential that the therapist has sound knowledge of the diagnosis, contributing factors and possible evolutions in order to adapt the treatment and limit the repercussions as much as possible.