November 2013

Prepare for landing: Bladed cleats may put fifth met at risk

In the moment: Sports medicine

11ITM-sports-iStock24930208v2By Greg Gargiulo

Bladed soccer cleats were associated with increased forefoot loading during a jump-landing task, which may lead to a higher risk of fifth metatarsal stress fractures, according to a study published in the September-October issue of the Journal of Athletic Training.

Robin M. Queen, PhD, director of the Michael W. Krzyzewski Human Performance Research Laboratory at the Duke University Medical Center in Durham, NC, and colleagues conducted a crossover study to investigate plantar-pressure differences during landing that might be related to gender and footwear. Previous research by Queen and others has shown that these factors can affect plantar loading during other athletic tasks (see “Fifth met stress fracture: Load-based risk factors”), but predicting stress fractures is still an inexact science.

“It is always a good practice to make sure that players are moving well and do not have any risk factors for injury prior to the start of any training or competitive season,” Queen said. “However, we currently do not have specific ways to screen for stress fracture injury risk.”

Researchers recruited 27 recreational soccer players (13 women) between the ages of 18 and 25 years with no recent history of lower extremity stress fractures. Wearing three different types of shoes (running shoes, bladed cleats, and turf cleats), participants jumped to head a suspended soccer ball and landed on a pressure plate. The investigators did not control for foot type but felt this factor would not have altered the overall results of the study, Queen said.

Men demonstrated higher force-time integral values than women beneath the medial forefoot, lateral forefoot, medial midfoot, and lateral midfoot. This suggests male athletes may load these regions of the foot longer than female athletes, and thus may be at an increased risk for metatarsal stress fractures in those areas.

In addition, bladed cleats were associated with significantly greater force-time integral and maximum force in the forefoot and midfoot regions compared to other shoe types. According to Queen, the lack of cushioning in bladed cleats is the main reason for this increased plantar loading, though the location and number of studs in these shoes may also be responsible.

Both sets of findings in the jump landing study were consistent with those of previous studies in which participants performed side cuts or crosscuts; sex differences have also been reported in studies involving running.

However, in a 2009 study published in The Physician & Sportsmedicine, researchers at the Texas Scottish Rite Hospital for Children in Dallas found the peak pressure values at the fifth metatarsal during accelerating and running straight were significantly higher than those for jumping or landing. Though that study assessed only football turf shoes and turf cleats, and jump task differences between the studies may also partly explain the disparity, the Dallas investigators’ findings suggest forefoot loading may be even greater during tasks other than jumping, and could be exacerbated when athletes wear bladed cleats, according to first author Michael S. Orendurff, PhD, who is now senior scientist and director of the biomechanics laboratory at Orthocare Innovations in Mountlake Terrace, WA.

“I think that combining acceleration/decelerating and jump takeoff and jump landing will load the forefoot even more,” Orendurff said.

Queen believes the findings from her study, which can also be applied to other sports that include regular jumping or wearing cleats, highlight the importance of footwear selection. Athletes returning from a forefoot injury might consider avoiding bladed cleats initially, and running shoes could be used for certain training tasks; however, the traction from cleats is essential for intense practice and game play, and should therefore be used appropriately.

More importantly, she said, “The best advice that can be given is to seriously examine the training schedule of the athletes and ensure they are given enough rest as well as ensuring they are adequately conditioned coming into the start of the season so that the body is able to handle the stresses of training and game play.”

Sources

DeBiasio BA, Russell ME, Butler RJ, et al. Changes in plantar loading based on shoe type and sex during a jump-landing task. J Athl Train 2013;48(5): 601-609.

Orendurff MS, Rohr ES, Segal AD, et al. Biomechanical analysis of stresses to the fifth metatarsal bone during sports maneuvers: implications for fifth meta­tarsal fractures. Phys Sportsmed 2009; 37(2):87-92.

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