1 Hospital for Special Surgery, New York, NY, USA.
2 Albany Medical College, Albany, NY, USA.
Foot Ankle Int. 2019 Mar;40(3):318-322. doi: 10.1177/1071100718809357. Epub 2018 Nov 7.
: Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Repetitive stresses endured by the fifth metatarsal can lead to stress fracture, delayed union, and refracture, making optimal treatment challenging. A radiographic analysis of fifth metatarsal morphology and foot type in National Football League (NFL) players was performed to investigate morphologic risk factors for these injuries.
: This was a case-control study that looked at NFL players treated between 1992 and 2012, as well as participants at the NFL Combine. Ninety-six feet (51 athletes) were included. Fractures were present in 15 feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior, lateral, and oblique radiographs. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined.
: On anteroposterior radiographs, significant differences in apex medullary canal width, 4-5 intermetatarsal angle, fifth metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet ( P = .001, .003, .004, .008, respectively). On lateral radiographs, significant differences in the fifth metatarsal length, distance to apex, apex height, fifth metatarsal angle, and talocalcaneal angle were observed between fractured and nonfractured feet ( P = .04, .01, .02, .01, .01, respectively). On oblique radiographs, a significant difference was observed in apex height between fractured and nonfractured feet ( P = .002).
: Individuals with long, narrow, and straight fifth metatarsals with an adducted forefoot were most at risk for fifth metatarsal fractures. With this insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at risk.
: Level III, retrospective comparative study.
第五跖骨骨折是运动员中最常见的足部损伤之一。第五跖骨承受的反复应力可导致应力性骨折、延迟愈合和再骨折，这使得最佳治疗具有挑战性。对美国国家橄榄球联盟（NFL）球员的第五跖骨形态和足型进行了放射分析，以研究这些损伤的形态学危险因素。
这是一项病例对照研究，研究对象为 1992 年至 2012 年间接受治疗的 NFL 球员以及 NFL 联合收割机的参与者。共纳入 96 只脚（51 名运动员）。15 只脚有骨折。两名评估员在前后位、侧位和斜位 X 线片上评估第五跖骨形态和足型。比较骨折组和非骨折组运动员的足型和跖骨形态差异。
在前位 X 线片上，骨折组和非骨折组之间的髓腔顶宽、4-5 跖骨间角、第五跖骨角和距骨头显露有显著差异（P =.001，.003，.004，.008）。在侧位 X 线片上，骨折组和非骨折组之间的第五跖骨长度、距顶点距离、顶点高度、第五跖骨角和跟距角有显著差异（P =.04，.01，.02，.01，.01）。在斜位 X 线片上，骨折组和非骨折组之间的顶点高度有显著差异（P =.002）。
第五跖骨长、窄、直，前脚内收的个体最容易发生第五跖骨骨折。有了这一认识，可以通过修改鞋类、使用矫形器和减压支具来预防骨折，这些方法可以考虑到那些使运动员面临风险的形态学特征。
III 级，回顾性比较研究。
