Stress fractures of the proximal phalanx of the great toe

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Stress fractures of the proximal phalanx of the great toe are very rare. We have encountered such fractures in four patients with no clear history of injury. The patients consisted of one male and three female high-level athletes. All were in their teens but their epiphyseal line had already closed. The three women exhibited a tendency toward hallux valgus. Three of the four patients were treated conservatively by local rest for several months. The other patient was treated surgically because she was not able to continue resting and pseudarthrosis had occurred. Surgical findings revealed that the fracture had occurred on the medial aspect of the plantar side of the proximal phalanx of the great toe and that no ligaments or tendons were attached to the fragment. This suggested that the cause of this fracture was not tension by ligaments but the shear force generated by striking the ground.