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Stress fractures of the great toe sesamoids

Department of Surgery, Division of Orthopedics, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

J.S. Keene, MD

Department of Surgery, Division of Orthopedics, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

T.A. Lange, MD

Department of Surgery, Division of Orthopedics, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

W.G. Clancy, JR., MD

Department of Surgery, Division of Orthopedics, University of Wisconsin Hospital and Clinics, Madison, Wisconsin

Stress fractures of the great toe sesamoids have not been previously confirmed as a clinical entity. In this report, we present four such cases, and document the diagnosis by histological sections. All of the patients had experienced the insidious onset of activity-related forefoot pain, and had radiographs that demonstrated a sesamoid fracture. None of the fractures healed with 6 weeks of immobilization and prolonged (4-6 months) inactivity. In all cases, the fractured sesamoid was excised, and the hematoxylin and eosin sections of the fracture segments documented the prefracture stress and incomplete repair characteristic of a stress fracture.

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