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.
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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)