Background: The literature shows an anecdotal relationship between high-arched feet and proximal fifth metatarsal stress fractures. This relationship has never been supported by sound scientific evidence. Our aim in this study was to examine whether athletes sustaining this injury are characterized by a static foot structure or a dynamic loading pattern during stance. Materials and Methods: Ten professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control uninjured soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation during stance. Each variable was compared between injured and uninjured feet. Results: Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation during stance revealed relative unloading of the fourth metatarsal in both the injured and sound limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes. Conclusion: Athletes who sustain proximal fifth metatarsal stress fracture are not characterized by an exceptional static foot structure. Dynamically lateral metatarsal unloading during the stance phase may either play a role in the pathogenesis of the injury, or alternatively represent an adaptive process. Clinical Relevance: Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics

Design: Retrospective chart and radiographic review. Background: Stress fractures of the fifth metatarsal are increasingly common among elite professional footballers (soccer players). This reflects the use of lighter, less protective and more flexible sports footwear combined with the increasingly physical demands of the professional game at the highest level. Stress fractures of the fifth metatarsal can be satisfactorily treated non-operatively by cast immobilisation and a graduated return to activity. The demands placed on the modern elite professional footballer are such that a different treatment approach is required for the same injury in this subgroup of patients. Methods: Stress fractures of the fifth metatarsal in elite professional footballers are treated by the senior author (JPH) by operative surgical fixation. We reviewed the charts and radiographs of all fifth metatarsal stress fractures that were treated operatively in elite professional footballers over a five year period. Details recorded included fracture location, method of fixation, complications, time to radiological union and time to return to independent weightbearing and competitive sporting activity. Results: There were 32 fifth metatarsal stress fractures in 30 elite professional footballers. All fractures were clinically united at a mean 5.5 weeks and radiologically united at a mean of 10.3 weeks. The patients could weightbear immediately and could independently weightbear from 4 weeks. The mean time to return to full competitive activity was 10.3 weeks. There were no complications. Conclusions: Operative treatment of fifth metatarsal stress fractures is an effective treatment in elite professional footballers that produces consistently good results and allows an early return to full activity

The February 2014 Foot & Ankle Roundup. 360 . looks at: optimal medial malleolar fixation; resurfacing in the talus; predicting outcome in mobility ankles; whether mal-aligned ankles can be successfully replaced; cartilage colonisation in bipolar ankle grafts; CTs and proof of fusion; recalcitrant Achilles tendinopathy; and recurrent fifth metatarsal stress fractures