April 2017

Proximal and distal factors may affect 5th met fracture risk in soccer players

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Clinicians looking to prevent fifth meta­tarsal fractures (Jones fractures) in soccer players may want to consider proximal as well as distal factors, according to studies from two separate Japanese research groups presented at the IOC World Conference on Prevention of Injury and Illness in Sport, held in Monaco in March.

A prospective study from Waseda University in Tokyo found that fifth metatarsal fracture was associated with lateralized plantar pressures during a heel raise and structural variables that also contribute to load lateralization.

Investigators prospectively assessed 310 male collegiate soccer players and followed them for one year. Those who went on to suffer a fifth metatarsal fracture were more likely to load the lateral aspect of both feet during standing weightbearing than those who were not injured. In addition, the injured foot was associated with more lateralized plantar pressures during heel raises at baseline than the contralateral foot.

Meanwhile, a second study from Jutendo University, also in Tokyo, found significantly reduced hip internal rotation— which can also lead to lateralization of plantar loads—in athletes with a history of fifth metatarsal fracture compared with those with no such history.

Researchers reviewed baseline biomechanical assessments for 20 professional soccer players who went on to experience a fifth metatarsal fracture and 40 players who did not. Hip internal rotation was significantly more limited in the injured players than the uninjured players, and in the injured players was also more limited in the hip corresponding to the injured foot than on the contralateral side.

The reduced hip internal rotation can lead to supination and lateralization of load in the foot, increasing the risk of fifth metatarsal fracture, said Yoshimoto Saita, MD, PhD, a researcher in the university’s department of orthopedics and sports medicine, who presented his group’s findings in Monaco.


Matsuda S, Hirose N, Fukubayashi T. The risk factors of fifth metatarsal stress fracture in football players. Br J Sports Med 2017;51(4):357.

Saita Y, Nagao M, Kobayashi Y, et al. Restriction in hip internal rotation and fifth metatarsal stress fractures (Jones fracture) in professional football players. Br J Sports Med 2017;51(4):380.

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