Fifth metatarsal stress fracture in elite male football players: an on-field analysis of plantar loading

Abstract

ObjectiveEvaluate plantar loading during ‘on-field’ common football movements in players after fifth metatarsal (MT-5) stress fracture and compare with matched healthy players.MethodsFourteen elite male soccer players participated in the study conducted on a natural grass playing surface using firm ground football boots. Seven players who had suffered a primary stress fracture (MT-5 group) and seven matched healthy players (controls, CON) performed three common football movements while in-shoe plantar loading data were collected.ResultsLarge between-group differences exist for maximal vertical force normalised to bodyweight (Fmax) at the lateral toes (2-5) of the stance leg during a set-piece kick (MT-5: 0.2±0.06 bodyweight (BW), CON: 0.1±0.05 BW, effect size (ES) 1.4) and the curved run where the MT-5 group showed higher Fmax with very large effect size at the lateral forefoot of the injured (closest to curve) limb when running a curve to receive a pass (MT-5 injured−CON=0.01 BW, ES 1.5). Small between-group differences were evident during straight-line running. However, between-limb analysis of MT-5 group showed significant unloading of the lateral forefoot region of the involved foot.ConclusionsElite male football players who have returned to play after MT-5 stress fracture display significantly higher maximum plantar force at the lateral forefoot and lateral toes (2-5) compared with healthy matched control players during two football movements (kick and curved run) with the magnitude of these differences being very large. These findings may have important implications for manipulating regional load during rehabilitation or should a player report lateral forefoot prodromal symptoms.

The Fifth Metatarsal Bone Fracture In Athletes ‐ Modalities of Treatment Related to Agility In Soccer Players

“…The risk of this exact injury may be related to the profile of the player, the position on the field and the type of training adequate for his/her field position. It has been shown that midfielders are more likely to have their metatarsal bone damaged, and the presented outcomes on this issue are consistent with the literature data ( Thomson et al, 2018 ).…”

“…Exogen), which shortens the time of bone regeneration and remodeling ( Nolte et al, 2016 ; Teoh et al, 2018 ). Implementing early conditioning, gait re-education and subsequent running are possible due to an anti-gravity treadmill (Alter G), which is gaining more popularity in innovative rehabilitation protocols ( Thomson et al, 2018 ). During the last phase of rehabilitation and in the programming of sports training, the player's position on the pitch should be taken into account.…”

“…During the last phase of rehabilitation and in the programming of sports training, the player's position on the pitch should be taken into account. According to the researchers' findings, non-linear running accumulates greater forces on the inside foot ( Thomson et al, 2018 ). Performing long passes during the game may significantly increase the loads on the lateral side of the foot.…”

“…Soccer, due to its requirements of covering up to 12 000 m in a game, frequent changes of direction and a multitude of various incidents (including fouls), seems to significantly increase the risk of foot injuries, including fractures among players ( Boraczyński et al, 2020 ). The player's position on the field has to be considered in this regard ( Thomson et al, 2018 ).…”

Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone

“…25 The second is traction stress caused by the tension of the tissues attached to the proximal part of the fifth metatarsal bone during ankle plantarflexion. 38 The risk factors for bending stress have been reported to be an increase in anterior lateral plantar pressure, 1,11,35,40 hindfoot varus alignment, 20,29 forefoot supination alignment, 21 metatarsal adduction alignment, 15,43 reduced toe grip force, 10 hip internal rotation limitation, 31 and narrow shoe width. 16 However, risk factors for traction stress have not been fully elucidated, and it has been pointed out that traction stress may have an adverse effect on fracture incidence and healing.…”