Proximal Fifth Metatarsal Fractures in Athletes: Management of Acute and Chronic Conditions

Bone Stress Injuries at the Ankle and Foot

Bone stress injuries (BSIs) are a frequent finding in athletes, particularly of the foot and ankle. A BSI is caused by recurring microtrauma to the cortical or trabecular bone exceeding the repair capacity of normal bone. The most frequent fractures at the ankle are low risk, characterized by a low risk for nonunion. These include the posteromedial tibia, the calcaneus, and the metatarsal diaphysis. High-risk stress fractures have a higher risk for nonunion and need more aggressive treatment. Examples are the medial malleolus, navicular bone, and the base of the second and fifth metatarsal bone.Imaging features depend on the primary involvement of cortical versus trabecular bone. Conventional radiographs may remain normal up to 2 to 3 weeks. For cortical bone, early signs of BSIs are a periosteal reaction or the "gray cortex sign," followed by cortical thickening and fracture line depiction. In trabecular bone, a sclerotic dense line may be seen. Magnetic resonance imaging enables early detection of BSIs and can differentiate between a stress reaction and a fracture. We review typical anamnestic/clinical findings, epidemiology and risk factors, imaging characteristics, and findings at typical locations of BSIs at the foot and ankle that may help guide treatment strategy and patient recovery.

Characteristics of Plantar Pressure with Foot Postures and Lower Limb Pain Profiles in Taiwanese College Elite Rugby League Athletes

Background: This study aimed to explore the differences in the distributions of plantar pressure in static and dynamic states and assess the possible pain profiles in the lower limb between elite rugby league athletes and recreational rugby players. Methods: A cross-sectional study of 51 college elite rugby athletes and 57 recreational rugby players was undertaken. The arch index (AI) and plantar pressure distributions (PPDs) with footprint characteristics were evaluated via the JC Mat. Rearfoot alignment was examined to evaluate the static foot posture. The elite group’s lower-limb pain profiles were examined for evaluating the common musculoskeletal pain areas. Results: The recreational group’s AI values fell into the normal range, whereas the elite group’s arch type fell into the category of the low arch. Results from the elite group were: (1) the PPDs mainly exerted on the entire forefoot and lateral midfoot regions in static standing, and transferred to the forefoot region during the midstance phase of walking; (2) the static rearfoot alignment matched the varus posture pattern; (3) the footprint characteristics illustrated the features of low-arched, supinated, dropped metatarsal heads and dropped cuboid feet; and (4) the phalanx and metatarsophalangeal joints, and the abductor hallucis and abductor digiti minimi of the plantar plate were common musculoskeletal pain areas. Conclusions: Characteristics of higher plantar loads beneath forefoot and midfoot associated with low-arched supinated feet in bipedal static stance could be the traceable features for the foot diagram of elite rugby league athletes. The limb pain profiles of the elite rugby league athletes within this study echoed the literature on rugby injuries, and reflected the features of metatarsophalangeal joint pains and dropped cuboids. The relationships among the low-arched supinated feet, metatarsophalangeal joint pains and cuboid syndrome are worth further studies.