Fifth metatarsal fractures among male professional footballers: a potential career-ending disease

Background There is little information about Metatarsal Five (MT-5) fractures for specific sports. Objective To study the occurrence, the imaging characteristics, the lay-off times and healing problems of MT-5 fractures among male footballers. Methods Sixty-four European elite teams were monitored from 2001 to 2012. x-Rays were collected and classified by the Torg criteria. Results Of 13754 injuries, 0.5% (67) proved to be MT-5 fractures. Their incidence was 0.04 injuries/1000h of exposure. A team of 25 players might thus expect an MT-5 fracture every fifth season. Of these fractures, 67% (38) were primary and 33% were refractures. One of the 38 primary fractures was an avulsion of the tuberosity; all the others (97%) located towards the base. In total, 32% of the players with MT-5 fracture were younger than 21years, 40% of the fractures occurred during the preseason and 45% of the players had prodromal symptoms. In total, 54% of the initial x-rays were classified as Torg type II (stress fractures), and 46% were classified as Torg type I (acute type). After surgical treatment the fractures healed faster, compared with conservative treatment (75% vs 33%, p<0.05). There was no significant difference in lay-off days between players that had been operated, and those that had not (80 vs 74days, p=0.67). Conclusions The majority of MT-5 fractures are stress fractures, and mainly occur among young players. There are frequent healing problems, which might be explained by the stress nature of the injury. After surgery there are less healing problems, compared with those in conservative treatment.