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Influence of Sport-Related Loading on Metatarsal Bone Mineral Density in High School Football Players

Authors:

Abstract

Fifth metatarsal (5M) fractures are common in a young athletic population, but the risk factors for this injury are not well understood. This study aimed to determine differences in sport-related loading in adolescent American football players with varying bone mineral densities (BMD) of the 5M.
PARTICIPANTS::56 male high school football
players participated (19 linemen and 37 skill players)
with 6.1±3.8 years of previous playing experience.
Monifa A. Williams1, Audrey Westbrook1, Anh-Dung Nguyen2,Thomas Hockenjos3, David R
Sinacore1, James Smoliga1, Jeffrey B. Taylor1, Kevin R. Ford1
Influence of Sport-Related Loading on Metatarsal Bone Mineral Density in
High School Football Players
SUMMARY AND CONCLUSIONS
REFERENCES
RESULTSINTRODUCTION
This study aimed to determine differences in sport-related
loading in adolescent American football players with
varying bone mineral densities (BMD) of the 5M.
PURPOSE
METHODS
High Point University, Congdon School of Health Sciences
1Department of Physical Therapy | 2Department of Athletic Training | 3Department of Exercise Science
METHODS
Metatarsophalangeal joint (MTPJ) and ankle joint (AJ) range of motion (ROM) and moments
were calculated during the propulsion phase of the trailing planted foot. Multiple one-way
analysis of variance tests (p<0.05) were used to test for significant biomechanical differences
between groups with post-hoc Bonferroni-corrected pairwise comparisons.
Fifth metatarsal (5M) fractures are common in a young
athletic population, but the risk factors for this injury
are not well understood.1Many studies have shown that
5M fractures are difficult to treat and are prone to
healing problems such as refractures and delayed
union.2,3
It is uncertain if bone remodeling is limited or if the
magnitude and frequency of chronic loading may
become detrimental to bone strength that leads to
injury.4
Adolescent football players with greater relative 5M/2M
BMD exhibit a biomechanical profile (greater MTPJ
moment & ROM) that may likely create a larger
bending moment at the metatarsals during a football-
related task.
Sport-related loading of the metatarsal is vital to the
remodeling process and though a high BMD may confer
a lower risk for 5M fracture, clinicians should also
consider that an anatomic region which is receiving a
higher biomechanical loads particularly, long bones
such as the 5M, undergo high bending forces during
sport-related loading that may increase risk of fracture.
ACKNOWLEDGMENTS
Standardized football cleats were donated by adidas (adidas®
crazyquick2.0, Portland, Oregon).
1. Roche et al. KSSTA; 2013 21.6: 1307-1315.
2. Kerkhoffs et al. BJSM ; 2012;46:6448.
3. Lee et al. KSSTA; 2011;19:8537
4. Wang et al. Asian J Exer Sp Sci 2014; 11; 36-45.
5. Pritchard et al. J Foot Ankle Res 2017; 10:52.
APTA Combined Sections Meeting; Washington, DC January 23rd January 26th 2019
Whole-body, second metatarsal (2M),
and 5M BMD was assessed with
dual-energy x-ray absorptiometry
(DXA) (Hologic). 5Players were
grouped into tertiles by the ratio of
fifth-to-second metatarsal BMD
(5low, 5mod, 5high).
Subjects completed 3 trials of a
maximum effort weighted sled push
(WSP) of 75%body mass on a
synthetic turf surface with an
embedded force platform. Kinetic and
kinematic data were collected using
3D motion analysis.
RESULTS
Figure 3: MTP Peak Moment in 5Mlow, 5Mmod, 5Mhigh
Figure 2: Weighted Sled Push (WSP )
Figure 1: DXA Scan
of 5M
5th Metatarsal 2nd Metatarsal Ratio
Push Force
ROM Moment
p<0.001 p<0.001p=0.79
p=0.017
p=0.04 p=0.03
Figure 3: Horizontal force
during WSP
Figure 4: 5th Metatarsal Bone Mineral
Density Figure 5: 2nd Metatarsal Bone Mineral
Density of 5Mlow, 5Mmod, and 5Mhigh Figure 5: 5th Metatarsal Bone Mineral
Density Ratio of 5M to 2M
Figure 6:MTPJ ROM and Moment 5Mlow, 5Mmod, and 5Mhigh
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  • Wang
Wang et al. Asian J Exer Sp Sci 2014; 11; 36-45.
  • Pritchard
Pritchard et al. J Foot Ankle Res 2017; 10:52.