Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study

Sports Medicine - Open, Aug 2017

Background There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. Methods The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg–heel alignment, non-weight-bearing leg–heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure. Results The non-weight-bearing leg–heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P = 0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P < 0.05). There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. Conclusions Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future.

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Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study

Matsuda et al. Sports Medicine - Open Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study Sho Matsuda 0 Toru Fukubayashi 1 Norikazu Hirose 1 0 Graduate School of Sport Sciences, Waseda University , 2-579-15 Mikajima, Tokorozawa Saitama 359-1192 , Japan 1 Faculty of Sport Sciences, Waseda University , Saitama , Japan Background: There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. Methods: The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg-heel alignment, non-weight-bearing leg-heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure. Results: The non-weight-bearing leg-heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P = 0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P < 0.05). There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. Conclusions: Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future. - The results of the present study suggest that an everted rearfoot and inverted forefoot alignment are associated with a history of fifth metatarsal stress fracture. Plantar pressure did not differ between the fifth metatarsal stress fracture group and the control group. Midfield players had significantly higher rates of fifth metatarsal stress fracture, whereas defenders had significantly lower rates. Background A fifth metatarsal stress fracture (MT-5 fracture) is a common injury in soccer players. In fact, a previous investigation of a European soccer league found that 78% of stress fractures occurring in professional soccer players involved the fifth metatarsal bone. The incidence was 0.037–0.04/1000 exposure hours [ 1, 2 ] and 0.10– 0.12/1000 athlete exposures in Japan [3]. The MT-5 fracture is well known and requires a long period to recover from [ 4–14 ]. Moreover, MT-5 fractures may not achieve union because of poor blood flow around the injured region (the proximal diaphysis) [ 15 ]. For instance, surgical treatment requires a shorter period (15.2 ± 10.5 weeks) before regaining the ability to play than conservative treatment (26.3 ± 11.0 weeks) [ 16 ]. Therefore, occasional surgical treatment is recommended for athletes [ 7, 11, 13, 16–18 ]. However, even if the MT-5 fracture is treated surgically, it takes at least 3–8 months before the individual can play sports again. Therefore, this injury has a negative impact on performance, and prevention of its occurrence is important. Moreover, MT-5 fractures are well known for their high recurrence rate [ 14 ]. The MT-5 fracture recurrence rate is 25%, which is much higher than that of hamstring strains (13%) [ 19 ] or ankle sprains (10.3%) [ 20 ]. Therefore, in addition to preventing the initial injury, it is important to prevent injury recurrence. As van Mechelen et al. proposed, identifying the mechanism and risk factors of the targeted injury is necessary for preventing injury [ 21 ]. A previous retrospective study suggested that an inverted rearfoot, which can be examined using radiographs, is a risk factor for MT-5 fracture [ 10, 22 ]. However, this screening procedure is difficult to generalize because X-ray assessment requires specific locations, equipment, and skilled technicians in the field. To resolve this issue, easier, alternative protocols for evaluating risk factors of MT-5 fractures, such as high medial longitudinal arch height [23] and plantar pressure [ 24 ] have been proposed. However, no consensus regarding risk factors for MT-5 fractures has been established because of a lack of studies with large (...truncated)


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Sho Matsuda, Toru Fukubayashi, Norikazu Hirose. Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study, Sports Medicine - Open, 2017, pp. 27, Volume 3, Issue 1, DOI: 10.1186/s40798-017-0095-y