Overuse Injuries in Soccer: the Fifth Metatarsal

[This post is written by Chris Hoina, CSCS – Athletic Development Coach at Athletic Lab, my sport performance training center in NC. You can follow him on twitter @chrishoina or read his blog.]

Overuse injuries are common in any sport, and are oftentimes difficult to prevent.  These injuries can manifest in a variety of ways, including stress fractures.  Overuse injuries are often caused by low-grade repetitive stress which exceeds tissue tolerance, stress fractures are also caused by repetitive stress which fatigue the underlying bone structures (Ekstrand & Torstveit, 2010).

Not all stress fractures are alike.  Some are less common and some heal faster than others.  A lesser-known stress fracture, one that will sideline a footballer for weeks, is the Fifth Metatarsal (MT-5) fracture.  While stress fractures are rare in professional football, the recovery time from a MT-5 fracture can take up to 3 months (Ekstrand & Torstveit, 2010).  Imagine your one of your starters being taken out of play from such a preventable injury.

Ekstrand & Torstveit (2010) conducted a study that followed three male leagues, UEFA Champions league, Swedish Super league, and an artificial turf league over the course of 8 consecutive seasons and logged a total of 51 stress fractures.  78% of these fractures were of the MT-5 (predominantly occurring at the base in ‘Zone B’) and its likelihood of occurrence was approximately every third season for a 25-man squad (Ekstrand & Torstveit, 2010).  While an MT-5 fracture is rare, the healing process can take months so it is important to understand how to prevent such injuries.

Ekstrand & Niek van Dijk (2013) conducted a similar study that tracked 3487 professional players in the UEFA and found that an astonishing 40% of all MT-5 fractures occur within the first 3 months of the season, generally in the non-dominant leg.  Many of the players complained of pain prior to the actual fracture and the mean ages were 23±3 years (Ekstrand & Niek van Dijk, 2013).  Many of the fractures occur at the base of the metatarsal and occur early in the beginning of the season (Ekstrand & Niek van Dijk, 2013).  It is thought that the transition from relative low-stress of off-season to the sudden increase in training of the pre-season will bring about overuse injuries.  It is recommended that increases in training volumes and intensities, especially for younger athletes be adjusted.  While surgical treatments for re-union of the MT-5 are high it is important to understand that even with the best of cases healing rates can take as long as 75±13 days (Ekstrand & Niek van Dijk, 2013).  The rate of incidence is rare, but like other overuse injuries they are most times preventable with the correct training interventions.  Progressive overload and thoughtful oversight of your athletes will ensure that injury rates stay low and that’s good news for everyone.

Reference:

  • Ekstrand, J. & Niek van Dijk, C. (2013). Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. British Journal of Sports Medicine, 47, 754-758.
  • Ekstrand, J. & Torstveit, M. K. (2010). Stress fractures in elite male football players. Scandinavian Journal of Medicine & Science in Sports, 22, 341-346.
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Mike Young

Director of Performance at Athletic Lab
Mike is the Head Fitness Coach for the North Carolina Courage and North Carolina FC. He is also the owner and Director of Performance at Athletic Lab sports performance training center. He previously served as the fitness coach for the Vancouver Whitecaps and Carolina Railhawks. He has a PhD in Biomechanics, an MS in Coaching Science, and a BSS in Exercise Physiology and has coached Olympic and professional athletes in Skeleton, Track & Field, MLS and NASL Soccer, PGA Golf, NFL Football, MLB Baseball and Olympic Weightlifting. He has lectured around the world and authored 2 books and dozens of research and coaching articles.