To the Editor.—
In 1967, Darby1 reviewed in The Journal 300 cases of stress fractures in which the most frequent fracture (43%) was in the calcaneus. Since the report of Darby, the Center for Stress Fractures in the Israel Defense Force (IDF) has collected reports of hundreds of stress fractures among soldiers; surprisingly, none of the fractures were in the calcaneus. After years of follow-up, it is obvious that the distribution of the stress fractures in the IDF is different from that reported in the US Army and in other countries. Eighty percent to 97% of the stress fractures in the IDF are in the tibia and femur.2,3 Recently, the first case of stress fracture of the calcaneus with x-ray and bone scan characteristics has been diagnosed. The only possible explanation for the rarity of this fracture in the IDF is a different training program. Gilbert and Johnson4
Giladi M, Alcalay J. Stress Fracture of the Calcaneus—Still an Enigma in the Israeli Army. JAMA. 1984;252(22):3128–3129. doi:10.1001/jama.1984.03350220036017
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