Dorsal First Ray Mobility in Women Athletes With a History of Stress Fracture of the Second or Third Metatarsal

Abstract

Study Design: Retrospective case-control study. Objective: To examine the amount of dorsal first ray mobility in subjects having a history of stress fracture of the second or third metatarsal as compared to control subjects, and to test the influence of navicular drop, length of the first ray, and generalized joint laxity on the measure of dorsal mobility. Background: Instability of the first ray may cause the lesser metatarsals to carry greater weight and contribute to the incidence of metatarsal stress fracture. Stability of the first ray is believed to be compromised when subtalar joint pronation continues into late stance, the first metatarsal is short, or an individual has generalized joint laxity. To date, no research has assessed the relationship of these etiological factors to the measure of first ray mobility. Methods and Measures: Fifteen women athletes having a history of a second or third metatarsal stress fracture were matched by age, body mass, and sport activity to women athletes without fracture. Dorsal first ray mobility was quantified by a device using a standard load of 55 N. Change in vertical height of the navicular during stance was the measure of foot pronation. Relative length of the first ray navicular segment compared to the length of the second ray navicular segment was measured by caliper. Generalized joint laxity was evaluated using the Beighton 9-point scale. Within-day repeated measures assessed reliability. Differences between groups were determined by independent t test. Multiple polynomial regression analysis assessed the relationship between dorsal mobility and navicular drop, length of the first ray, and joint laxity. Results: Interrater reliability coefficients ranged from 0.36 for metatarsal length to 0.71 for navicular drop. The intrarater reliability coefficient for dorsal first ray mobility was 0.93. Dorsal first ray mobility was not significantly different between the 2 groups. With regression analysis, the Beighton score was the only variable retained as a significant predictor of dorsal mobility (R 2 = 0.24). Conclusion: Results do not support the theory that describes the unstable first ray as a common cause of metatarsal stress fracture. In addition, this investigation found generalized joint laxity to be a significant predictor of dorsal first ray mobility.

Metatarsal geometry and the indication for stress fractures

“…This agreed with Glasoe et al [7] who stated that the 2 nd and 3 rd MT's had the greatest incidence of MT stress fractures.…”

“…Our main focus were on the 2 nd and 3 rd MT's since they are the most common locations for MT stress fractures, and account for 75% of all MT stress fractures in sports [7]. The 2 nd MT increased in length by 0.05% and decreased in width by 10.7% showing a 40.54% increase in the stress potential (Table 1) between the two groups.…”

Foot Symmetry and Plantar Pressure Characteristics in Elite Taekwondo Athletes; Preferred and Non-Preferred Foot Comparison

“…36 Metatarsal injuries and fractures are relatively common injury that may affect the foot function and performance. 41,42 The M2 and M3 are prone to stress fractures if subject has a low or collapsed longitudinal arch or other foot disabilities. These pathologies change the weight bearing of the foot because of the extreme stress loading on these metatarsals.…”

Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations

“…25 Achilles contracture has been hypothesised to increase plantar pressure, thus increasing risk of a metatarsal stress fracture. 36 Ringham et al 37 have suggested that excessive external rotation of the hip from femoral antetorsion produces foot hyperpronation, which may lead to stress fractures in the lower extremities.…”