{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T03:53:27Z","timestamp":1780890807271,"version":"3.54.1"},"reference-count":39,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The objective of this study was to evaluate sex differences in the incidence and risk of ankle\u2013foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      The Defense Medical Epidemiology Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (\n                      <jats:italic toggle=\"yes\">i.e.<\/jats:italic>\n                      , male and female) occupations were compared with nonintegrated (\n                      <jats:italic toggle=\"yes\">i.e.<\/jats:italic>\n                      , male only) occupations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years (p-y) for males and 5.78 per 1,000 p-y for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation (relative risk [RR]\u2009=\u20095.74; 95% confidence interval [CI]: 4.80\u20136.87) and artillery\/gunnery (RR\u2009=\u20095.15; 95% CI: 4.62\u20135.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and nonintegrated occupations (\n                      <jats:italic toggle=\"yes\">i.e.<\/jats:italic>\n                      , special forces, infantry, and mechanized\/armor).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jwh.2021.0292","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T13:53:07Z","timestamp":1638280387000},"page":"586-592","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Sex Differences in the Incidence and Risk of Ankle\u2013Foot Complex Stress Fractures Among U.S. Military Personnel"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1020-7390","authenticated-orcid":false,"given":"Andrew J.","family":"MacGregor","sequence":"first","affiliation":[{"name":"Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA."},{"name":"Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA."},{"name":"Axiom Resource Management, Inc., San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3273-6536","authenticated-orcid":false,"given":"Sarah A.","family":"Fogleman","sequence":"additional","affiliation":[{"name":"Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA."},{"name":"Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber L.","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA."},{"name":"Leidos, Inc., San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille P.","family":"Ryans","sequence":"additional","affiliation":[{"name":"Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA."},{"name":"Department of Orthopedic Surgery, Naval Hospital Jacksonville, Jacksonville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cory F.","family":"Janney","sequence":"additional","affiliation":[{"name":"Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA."},{"name":"Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9697-3795","authenticated-orcid":false,"given":"John J.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA."},{"name":"Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,19]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2014.06.002"},{"key":"e_1_3_5_3_2","unstructured":"Gun BK McCoy AC Wang KC Waterman BR. 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