Abstract
Purpose
5th metatarsal stress fractures are frequently encountered in professional football. There is concern that early return to play following intra-medullary screw fixation may lead to an increased risk of delayed union. The purpose of the study was to assess whether an early return to play after surgical fixation of 5th metatarsal fractures in professional football players is a risk factor for delayed union and the effect of this on the ultimate clinical outcome.
Methods
Retrospective review of prospectively collected data of a series of 37 professional football players following intramedullary screw fixation of 5th metatarsal stress fractures. End points included time of return to play and to radiological union of the fracture.
Results
At a minimum follow-up of 24 months the mean return to play was 10.5 weeks and mean time to complete radiological union was 12.7 weeks. Return to play at 8 weeks or less resulted in a higher risk of delayed radiological union (24% at 3 months), but this neither prevented the athlete from continuing to play football nor did it affect the ultimate risk of non-union (3% overall). A re-fracture occurred in 1 patient (3%) at 10 months who previously had complete radiographic union at 9 weeks.
Conclusion
Intramedullary screw fixation of 5th metatarsal stress fractures leads to a predictable time of return to play and a low rate of non-union. If players return to play at 8 weeks or less a persistent line may be expected in up to a quarter of patients. However, if asymptomatic this radiological finding does not mean that athletes must avoid playing football as ultimately a good outcome is expected with low rates of non-union and refracture.
Level of evidence
Case series, Level IV.
Similar content being viewed by others
Abbreviations
- MT:
-
Metatarsal
- RTP:
-
Return to play
References
Azevedo R, da Rocha E, Franco P,et al (2017) Plantar pressure asymmetry and risk of stress injuries in the foot of young soccer players. Phys Ther Sport 24:39–43
Carl H, Pauser J, Swoboda B et al (2014) Soccer boots elevate plantar pressures in elite male soccer professionals. Clin J Sport Med 24(1):58–61
Carreira D, Sandilands S (2013) Radiographic factors and effect of fifth metatarsal jones and diaphyseal stress fractures on participation in the NFL. Foot Ankle Int 34(4):518–522
Clutton J, Perera A (2016) Vitamin D insufficiency and deficiency in patients with fractures of the fifth metatarsal. The Foot 27:50–52
Ekstrand J, Niek van Dijk C (2013) Fifth Metatarsal Fractures among male professional footballers: a potential career-ending disease. Br J Sports Med 47:754–808
Ekstrand J, Torstveit M (2012) Stress fracture in elite male football players. Scand J Med Sci Sports 22:341–346
Fujitaka K, Taniguchi A, Isomoto S et al (2015) Pathogenesis of fifth metatarsal fractures in college soccer players. Orthop J Sports Med 3(9):2325967115603654
Hetsroni I, Nyska M, Ben-Sira D et al (2010) Analysis of foot structure in athletes sustaining proximal fifth metatrarsal stress fracture. Foot Ankle Int 31(3):203–211
Japjec M, Staresinic M, Starjacki M et al (2015) Treatment of proximal fifth metatarsal bone fractures in athletes. Injury 465:S134–S136
Kaeding C, Yu J, Wright R et al (2005) Management and return to play of stress fractures. Clin J Sport Med 15(6):442–447
Kerkhoffs G, Versteegh V, Sierevelg I et al (2012) Treatment of proximal metatarsal V fractures in athletes and non-athletes. Br J Sports Med 46:644–648
Lee K, Park Y, Yong K et al (2011) The Plantar Gap: another prognostic factor for fifth metatarsal stress fracture. Am J Sports Med 39(10):2206–2211
Mallee W, Weel H, Niek van Dijk X et al (2015) Surgical versus conservative treatment for high-risk stress fractures of the lower leg: a systematic review. Br J Sports Med 49:376–379
Orendurff M, Rohr E, Segal A et al (2009) Biomechanical analysis of stresses to the fifth metatarsal bone during sports maneuvers: implications for fifth metatarsal fractures. Phys Sports Med 37(2):87–92
Polzer H, Polzer S, Mutschler W et al (2012) Acute fractures of the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury 43:1626–1632
Robertson G, Wood A (2017) Lower limb stress fractures in sport: optimising their management and outcome. World J Orthop 18(3):242–255
Shimasaki Y, Nagao M, Miyamori T al (2016) Evaluating the risk of a fifth metatarsal stress fracture by measuring the serum 25-hydroxivitamin D levels. Foot Ankle Int 37(3):307–311
Thevendran G, Deo R, Calder J (2013) Fifth metatarsal fractures in the athlete: evidence for management. Foot Ankle Clin 18:237–254
Torg J, Baldwin E, Zelk R et al (1984) Fractures of the base of the fifth metatarsal distal to the tuberosity: classification and guidelines for non-surgical and surgical management. J Bone Jt Surg Am 66:209–214
Tsukada S, Ikeda H, Seki Y et al (2012) Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series. Sports Med Arthrosc Rehabil Ther Technol 4(25):1–7
Wamelink K, Marcoux J, Walrath S (2016) Rare Proximal diaphyseal stress fractures of the fifth metatarsal associated with metatarsus adductus. J Foot Ankle Surg 55:768–793
Wong P, Chamari K, Mao D et al (2007) Difference in plantar pressure between the preferred and non-preferred feet in four soccer-related movements. Br J Sports Med 41:84–92
Yates J, Feeley I, Sasikumar S et al (2015) Jones Fracture of the fifth metatarsal: is operative intervention justified? A systematic review of the literature and meta-analysis of results. The Foot 25:251–257
Funding
No funding was requried for this study.
Author information
Authors and Affiliations
Contributions
DM: Drafting and writing of manuscript, interpretation of data. DM Acquisition of data, design of article. MJ: Acquisition of data. JC: Drafting and writing of manuscript, interpretation of data, supervision of project.
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest.
Ethical approval
Local board review confirmed that full ethical approval was not required.
Rights and permissions
About this article
Cite this article
Miller, D., Marsland, D., Jones, M. et al. Early return to playing professional football following fixation of 5th metatarsal stress fractures may lead to delayed union but does not increase the risk of long-term non-union. Knee Surg Sports Traumatol Arthrosc 27, 2796–2801 (2019). https://doi.org/10.1007/s00167-018-5104-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-018-5104-2