ORIGINAL RESEARCH AR TIC L E Open Access
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
, Toru Fukubayashi
and Norikazu Hirose
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
Midfield players had significantly higher rates of fifth
metatarsal stress fracture, whereas defenders had
significantly lower rates.
A fifth metatarsal stress fracture (MT-5 fracture) is a
common injury in soccer players. In fact, a previous in-
vestigation 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 .
* Correspondence: email@example.com
Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima,
Tokorozawa Saitama 359-1192, Japan
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Matsuda et al. Sports Medicine - Open (2017) 3:27