Why are patients with flat feet at increased risk of metatarsal stress fractures?

Updated: Jan 16, 2019
  • Author: Valerie E Cothran, MD; Chief Editor: Craig C Young, MD  more...
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Queen et al investigated whether foot type (flat or normal) resulted in loading differences during four sport-specific tasks (cross-cut, side-cut, shuttle run, and landing from a simulated lay-up). [10] Of 22 healthy individuals, 12 had normal feet and 10 had flat feet, and each completed 5 trials per condition. In-shoe pressure data were collected at 50 Hz, and analyses of the entire foot and 8 regions of the foot were carried out on contact area, maximum force, and the force time integral. The investigators' findings included the following statistically significant (P< 0.05) findings [10] :

Flat feet

See the list below:

  • During the cross-cut task, there was an increase in medial midfoot contact area.

  • During the side-cut task, an increase in contact area, force time integral, and maximum force in both the medial and lateral midfoot were demonstrated.

  • During the shuttle run task, an increase in force time integral in the lateral midfoot and increases in maximum force in both the medial and lateral midfoot were present

  • During the landing task, an increase in maximum force in the medial midfoot was present. However, flat feet showed a decrease in middle forefoot maximum force.

Queen et al concluded that individuals with a normal foot may have a lower risk for medial and lateral midfoot injuries such as metatarsal stress fractures. Thus, foot type should be assessed when determining an individual's risk for metatarsal stress fractures. [10]

A case-control study that included 51 NFL players reported increased risk for fifth metatarsal fractures in players with long, narrow, and straight fifth metatarsals with an adducted forefoot. [11]

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