Skip to main content
SpringerLink
Log in
Book cover

Return to Play in Football pp 387–407Cite as

Return to Play in Stress Fractures of the Foot

  • Chapter
  • First Online:

  • 2805 Accesses

Abstract

Stress fractures of the foot are rare in professional football but are known to cause long absences from the game. All bones of the lower extremity can be affected; however, load-bearing bones are more often involved in football. Navicular and fifth metatarsal bone stress fractures (in particular) show a high risk of delayed union and non-union. Recurrent submaximal loading with inadequate recovery are most likely among the major contributors; however, this chapter will also cover several other intrinsic and extrinsic risk factors that should be screened. Delayed diagnosis of stress fractures of the foot can lead to unsatisfactory results. A high index of suspicion, without delay in further investigation, is mandatory. Initial treatment consists mostly of activity/load modification and rest. Early surgical intervention is indicated in case of “high-risk” fractures that are prone to displacement or non-union. This chapter will focus on the specificities of football-related foot stress fractures and show how proactive management can lead to good results and early return to play.

This is a preview of subscription content, log in via an institution.

Top Five Evidence Based References

  • D’Hooghe P, Wiegerinck JI, Tol JL, Landreau PA (2015) 22-year-old professional soccer player with atraumatic ankle pain. Br J Sports Med 49(24):1589–1590

    Article  PubMed  Google Scholar 

  • Ekstrand J, van Dijk CN (2013) Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. Br J Sports Med 47(12):754–758

    Article  PubMed  Google Scholar 

  • Saxena A, Fullem B, Hannaford D (2000) Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system. J Foot Ankle Surg 39(2):96–103

    Article  CAS  PubMed  Google Scholar 

  • Torg JS, Balduini FC, Zelko RR 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 Joint Surg Am 66(2):209–214

    Article  CAS  PubMed  Google Scholar 

  • Torstveit M, Sundgot-Borgen J (2005) The elite female athlete triad: are elite athletes at increased risk? Med Sci Sports Exerc 37:184–193

    Article  PubMed  Google Scholar 

References

  1. Ekstrand J, van Dijk CN (2013) Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. Br J Sports Med 47(12):754–758

    Article  PubMed  Google Scholar 

  2. Torstveit M, Sundgot-Borgen J (2005) The elite female athlete triad: are elite athletes at increased risk? Med Sci Sports Exerc 37:184–193

    Article  PubMed  Google Scholar 

  3. Hossain M, Clutton J, Ridgewell M, Lyons K, Perera A (2015) Stress fractures of the foot. Clin Sports Med 34:769–790

    Article  PubMed  Google Scholar 

  4. Mann JA, Pedowitz DI (2009) Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin 14(2):187–204

    Article  PubMed  Google Scholar 

  5. Kapandji IA (1970) The physiology of the joints: annotated diagrams of the mechanics of the human joints, 2nd edn. Churchill Livingstone, London

    Google Scholar 

  6. vanLangelaan EJ (1983) A kinematical analysis of the tarsal joints. An X-ray photogram- metric study. Acta Orthop Scand Suppl 204:1–269

    CAS  Google Scholar 

  7. Lee S, Anderson RB (2004) Stress fractures of the tarsal navicular. Foot Ankle Clin 9(1):85–104

    Article  PubMed  Google Scholar 

  8. Saxena A, Fullem B, Hannaford D (2000) Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system. J Foot Ankle Surg 39(2):96–103

    Article  CAS  PubMed  Google Scholar 

  9. Tuthill HL, Finkelstein ER, Sanchez AM et al (2014) Imaging of tarsal navicular disorders: a pictorial review. Foot Ankle Spec 7(3):211–225

    Article  PubMed  Google Scholar 

  10. Fowler JR, Gaughan JP, Boden BP et al (2011) The non-surgical and surgical treatment of tarsal navicular stress fractures. Sports Med 41(8):613–619

    Article  PubMed  Google Scholar 

  11. Khan KM, Fuller PJ, Brukner PD et al (1992) Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med 20(6):657–666

    Article  CAS  PubMed  Google Scholar 

  12. Torg JS, Moyer J, Gaughan JP et al (2010) Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. Am J Sports Med 38(5):1048–1053

    Article  PubMed  Google Scholar 

  13. Jacob KM, Paterson RS (2013) Navicular stress fractures treated with minimally invasive fixation. Indian J Orthop 47(6):598–601

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fitch KD, Blackwell JB, Gilmour WN (1989) Operation for non-union of stress fracture of the tarsal navicular. J Bone Joint Surg Br 71(1):105–110

    Article  CAS  PubMed  Google Scholar 

  15. Choi LE, Chou LB (2006) Surgical treatment of tarsal navicular stress fractures. Oper Tech Sports Med 14(4):248–251

    Article  Google Scholar 

  16. Saxena A, Fullem B (2006) Navicular stress fractures: a prospective study on athletes. Foot Ankle Int 27(11):917–921

    Article  PubMed  Google Scholar 

  17. Burne SG, Mahoney CM, Forster BB et al (2005) Tarsal navicular stress injury: long- term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Am J Sports Med 33(12):1875–1881

    Article  PubMed  Google Scholar 

  18. Davidson G, Pizzari T, Mayes S (2007) The influence of second toe and metatarsal length on stress fractures at the base of the second metatarsal in classical dancers. Foot Ankle Int 28(10):1082–1086

    Article  PubMed  Google Scholar 

  19. Kaipel M, Krapf D, Wyss C (2011) Metatarsal length does not correlate with maximal peak pressure and maximal force. Clin Orthop Relat Res 469(4):1161–1166

    Article  PubMed  Google Scholar 

  20. Arangio GA, Beam H, Kowalczyk G et al (1998) Analysis of stress in the metatarsals. Foot Ankle Surg 4:123–128

    Article  Google Scholar 

  21. Harato K, Ozaki M, Sakurai A et al (2014) Stress fracture of the first metatarsal after total knee arthroplasty: two case reports using gait analysis. Knee 21(1):328–331

    Article  PubMed  Google Scholar 

  22. Watson HI, O’Donnell B, Hopper GP et al (2013) Proximal base stress fracture of the second metatarsal in a Highland dancer. BMJ Case Rep 2013

    Google Scholar 

  23. Chuckpaiwong B, Cook C, Pietrobon R et al (2007) Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med 41(8):510–514

    Article  PubMed  PubMed Central  Google Scholar 

  24. Saxena A, Krisdakumtorn T, Erickson S (2001) Proximal fourth metatarsal injuries in athletes: similarity to proximal fifth metatarsal injury. Foot Ankle Int 22(7):603–608

    Article  CAS  PubMed  Google Scholar 

  25. Rongstad KM, Tueting J, Rongstad M et al (2013) Fourth metatarsal base stress fractures in athletes: a case series. Foot Ankle Int 34(7):962–968

    Article  PubMed  Google Scholar 

  26. Torg JS, Balduini FC, Zelko RR 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 Joint Surg Am 66(2):209–214

    Article  CAS  PubMed  Google Scholar 

  27. Clutton J, Perera A (2016) Insufficiency and deficiency of vitamin D in patients with fractures of the fifth metatarsal. Foot (Edinb) 27:50–52

    Article  Google Scholar 

  28. Romani WA, Gieck JH, Perrin DH et al (2002) Mechanisms and management of stress fractures in physically active persons. J Athl Train 37(3):306–314

    PubMed  PubMed Central  Google Scholar 

  29. Logan AJ, Dabke H, Finlay D et al (2007) Fifth metatarsal base fractures: a simple classification. Foot Ankle Surg 13(1):30–34

    Article  Google Scholar 

  30. Nagao M, Saita Y, Kameda S et al (2012) Headless compression screw fixation of jones fractures: an outcomes study in Japanese athletes. Am J Sports Med 40(11):2578–2582

    Article  PubMed  Google Scholar 

  31. 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(1):25

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ochenjele G, Ho B, Switaj PJ et al (2015) Radiographic study of the fifth metatarsal for optimal intramedullary screw fixation of Jones fracture. Foot Ankle Int 36(3):293–301

    Article  PubMed  Google Scholar 

  33. Hunt KJ, Goeb Y, Esparza R et al (2014) Site-specific loading at the fifth metatarsal base in rehabilitative devices: implications for Jones fracture treatment. PM R 6(11):1022–1029

    Article  PubMed  Google Scholar 

  34. Lee KT, Park YU, Jegal H et al (2013) Factors associated with recurrent fifth metatarsal stress fracture. Foot Ankle Int 34(12):1645–1653

    Article  PubMed  Google Scholar 

  35. Queen RM, Charnock BL, Garrett WE et al (2008) A comparison of cleat types during two football-specific tasks on fieldturf. Br J Sports Med 42(4):278–84; discussion 284

    Article  CAS  PubMed  Google Scholar 

  36. Thomson A, Akenhead R, D’hooghe P, et al (2017) Plantar loading in elite male football players with 5th metatarsal fracture. (In review).

    Google Scholar 

  37. Eils E, Streyl M, Linnenbecker S et al (2004) Characteristic plantar pressure distribution patterns during soccer-specific movements. Am J Sports Med 32(1):140–145

    Article  PubMed  Google Scholar 

  38. Sims EL, Hardaker WM, Queen RM (2008) Gender differences in plantar loading during three soccer-specific tasks. Br J Sports Med 42(4):272–277

    Article  CAS  PubMed  Google Scholar 

  39. 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

    Article  PubMed  PubMed Central  Google Scholar 

  40. Thomson A, Rennie D (2016) Evolution of natural grass playing surfaces for elite football. Aspetar J 5(2)

    Google Scholar 

  41. Smith N, Dyson R, Janaway L (2004) Ground reaction force measures when running in soccer boots and soccer training shoes on a natural turf surface. Sports Eng 73:159–167

    Article  Google Scholar 

  42. Sterzing T, Müller C, Hennig EM et al (2009) Actual and perceived running performance in soccer shoes: a series of eight studies. Footwear Sci 1(1):5–17

    Article  Google Scholar 

  43. Bentley JA, Ramanathan AK, Arnold GP, Wang W, Abboud RJ (2011) Harmful cleats of football boots: a biomechanical evaluation. Foot Ankle Surg 17(3):140–144

    Article  CAS  PubMed  Google Scholar 

  44. Jain N, Murray D, Kemp S et al (2012) Foot & ankle injuries in elite professional footballers: the findings of one English Premier League team. J Bone Joint Surg Br 94:249–249

    Article  Google Scholar 

  45. Yu B, Preston JJ, Queen RM, Byram IR, Hardaker WM, Gross MT et al (2007) Effects of wearing foot orthosis with medial arch support on the fifth metatarsal loading and ankle inversion angle in selected basketball tasks. J Orthopaed Sports Phys Ther 37(12):186–191

    Article  Google Scholar 

  46. Queen RM, Abbey AN, Verma R et al (2014) Plantar loading during cutting while wearing a rigid carbon fiber insert. J Athl Train 49(3):297–303

    Article  PubMed  PubMed Central  Google Scholar 

  47. Raikin SM, Slenker N, Ratigan B (2008) The association of a varushindfoot and fracture of the fifth metatarsal metaphyseal-diaphyseal junction: the jones fracture. Am J Sports Med 36(7):1367–1372

    Article  PubMed  Google Scholar 

  48. Nunns MP, Dixon SJ, Clarke J, Carré M (2015) Boot-insole effects on comfort and plantar loading at the heel and fifth metatarsal during running and turning in soccer. J Sports Sci 22:1–8

    Google Scholar 

  49. D’Hooghe P, Wiegerinck JI, Tol JL, Landreau PA (2015) 22-year-old professional soccer player with atraumatic ankle pain. Br J Sports Med 49(24):1589–1590. (Free Article)

    Article  PubMed  Google Scholar 

  50. Moretti B, Notarnicola A, Garofalo R et al (2009) Shock waves in the treatment of stress fractures. Ultrasound Med Biol 35(6):1042–1049

    Article  PubMed  Google Scholar 

  51. Furia JP, Rompe JD, Cacchio A et al (2010) Shock wave therapy as a treatment of non-unions, avascular necrosis, and delayed healing of stress fractures. Foot Ankle Clin 15(4):651–662

    Article  PubMed  Google Scholar 

  52. Busse JW, Kaur J, Mollon B et al (2009) Low intensity pulsed ultrasonography for fractures: systematic review of randomised controlled trials. BMJ 338:b351

    Article  PubMed  PubMed Central  Google Scholar 

  53. Beck BR, Matheson GO, Bergman G et al (2008) Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am J Sports Med 36(3):545–553

    Article  PubMed  Google Scholar 

  54. Raghavan P, Christofides E (2012) Role of teriparatide in accelerating metatarsal stress fracture healing: a case series and review of literature. Clin Med Insights Endocrinol Diabetes 5(5):39–45

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports medical Hospital, Aspire Zone, Sports city street 1, P.O. Box 29222, Doha, Qatar

    Pieter d’Hooghe

  2. Department of Sports Podiatry, Aspetar Orthopaedic and Sports medical Hospital, Aspire Zone, Sports city street 1, P.O. Box 29222, Doha, Qatar

    Athol Thomson

Authors
  1. Pieter d’Hooghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Athol Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pieter d’Hooghe .

Editor information

Editors and Affiliations

  1. UPMC Rooney Sports Complex, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Werner Krutsch

  4. Santa Monica, California, USA

    Bert R. Mandelbaum

  5. Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal

    João Espregueira-Mendes

  6. Orthopaedic Surgery, Aspetar Hospital, Doha, Qatar

    Pieter d'Hooghe

Rights and permissions

Reprints and permissions

Copyright information

© 2018 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

d’Hooghe, P., Thomson, A. (2018). Return to Play in Stress Fractures of the Foot. In: Musahl, V., Karlsson, J., Krutsch, W., Mandelbaum, B., Espregueira-Mendes, J., d'Hooghe, P. (eds) Return to Play in Football. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55713-6_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-55713-6_30

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55712-9

  • Online ISBN: 978-3-662-55713-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation