Stress fracture of medial sesamoid of the hallux in a middle-distance runner

A 22 year old man, left-handed, without medical history, middle-distance runner, consulting for the pain on the right forefoot. The patient reported that the pain has evolved for 3 weeks with an exacerbation during the last 3 weeks. Its located on the hallux and worsened by training. The patient doesn´t remember any intense trauma to the foot. He had previously consulted several doctors who prescribed NSAIDs without any sport restriction. The walking examination found a pain on the propulsion phase of the right foot. Right monopodial support was painless. Palpation found a pain in the volar face of the first MTP joint. Right forefoot X-rays showed a fracture of the medial sesamoid of the hallux (A and B). The treatment consisted of a first MTP joint discharge by a Barouk shoe associated with NSAIDs for 2 weeks. Sports activities requiring support were stopped for 10 weeks. The sport level was maintained by daily swimming sessions and biking. Physical rehabilitation by cryotherapy and mechanical compression was also used. At 15 weeks follow up, the patient returned to his professional sports activities without any pain. He reached the performance level sport at 18 weeks.