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Fifth metatarsal stress fracture in elite male football players: an on-field analysis of plantar loading
  1. Athol Thomson1,2,
  2. Richard Akenhead3,
  3. Rodney Whiteley4,
  4. Pieter D'Hooghe4,
  5. Ken Van Alsenoy4,
  6. Chris Bleakley5
  1. 1 Exercise and Sports Science Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Ulster Sports Academy, University of Ulster, Ulster, UK
  3. 3 Football Association, Burton Upon Trent, UK
  4. 4 Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5 Department of Physical Therapy, School of Health Sciences, High Point University, High Point, North Carolina, USA
  1. Correspondence to AtholThomson; Athol.Thomson{at}


Objective Evaluate plantar loading during ‘on-field’ common football movements in players after fifth metatarsal (MT-5) stress fracture and compare with matched healthy players.

Methods Fourteen elite male soccer players participated in the study conducted on a natural grass playing surface using firm ground football boots. Seven players who had suffered a primary stress fracture (MT-5 group) and seven matched healthy players (controls, CON) performed three common football movements while in-shoe plantar loading data were collected.

Results Large between-group differences exist for maximal vertical force normalised to bodyweight (Fmax) at the lateral toes (2-5) of the stance leg during a set-piece kick (MT-5: 0.2±0.06 bodyweight (BW), CON: 0.1±0.05 BW, effect size (ES) 1.4) and the curved run where the MT-5 group showed higher Fmax with very large effect size at the lateral forefoot of the injured (closest to curve) limb when running a curve to receive a pass (MT-5 injured−CON=0.01 BW, ES 1.5). Small between-group differences were evident during straight-line running. However, between-limb analysis of MT-5 group showed significant unloading of the lateral forefoot region of the involved foot.

Conclusions Elite male football players who have returned to play after MT-5 stress fracture display significantly higher maximum plantar force at the lateral forefoot and lateral toes (2-5) compared with healthy matched control players during two football movements (kick and curved run) with the magnitude of these differences being very large. These findings may have important implications for manipulating regional load during rehabilitation or should a player report lateral forefoot prodromal symptoms.

  • Soccer
  • metatarsal
  • stress fracture
  • Plantar pressure
  • football

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  • Twitter @ATholThomson

  • Contributors AT and RA conceived the study. All authors collected data and wrote the manuscript. RW and KVA performed the statistical analysis. PD shared surgical expertise. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the ethics committee of the Anti-Doping Lab Qatar institutional review board (IRB no. F2016000194).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement A full dataset of all plantar loading parameters can be provided on request.