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Playing football on artificial turf as a risk factor for fifth metatarsal stress fracture: a retrospective cohort study
  1. Takayuki Miyamori1,2,
  2. Masashi Nagao2,3,4,
  3. Ryuichi Sawa1,
  4. Steve Tumilty5,
  5. Masafumi Yoshimura6,
  6. Yoshitomo Saita2,4,
  7. Hiroshi Ikeda7,
  8. Kazuo Kaneko4
  1. 1 Department of Health and Welfare, School of Physical Therapy, International University of Health and Welfare, Narita, Japan
  2. 2 Jones Fracture Research Group, Tokyo, Japan
  3. 3 Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
  4. 4 Department of Orthopaedics and Sports Medicine, Juntendo University, Tokyo, Japan
  5. 5 Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand
  6. 6 Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
  7. 7 Department of Orthopaedics and Sports Medicine, Juntendo University, Tokyo, Japan
  1. Correspondence to Dr Masashi Nagao; nagao{at}


Objective The fifth metatarsal stress fracture is a common injury among football players. Although several risk factors have been proposed, the association between the playing surface and development of fifth metatarsal stress fractures (MT-5) has not been evaluated. We conducted an epidemiological study using a computer-based survey to investigate the association between the playing surface and development of MT-5.

Methods This study included 1854 football players, of which 41 experienced MT-5 within the past 24 months. Baseline demographic data and the percentage of time spent playing on artificial turf and clay fields were compared between the non-MT-5 and MT-5 player groups, and the risks for development of MT-5 associated with the playing surfaces were estimated by univariate and multivariate analyses.

Results There were significant differences in body mass index, years of play, playing categories and playing time on artificial turf between non-MT-5 and MT-5 groups (p<0.05). Generalised estimating equations analyses adjusted for multiple confounders demonstrated that relative to the risk of playing <20% of the time on each surface, the OR (OR: 95% CI) for MT-5 for playing on artificial turf >80% of the time increased (3.44: 1.65 to 7.18), and for playing on a clay field 61%–80% of the time, the OR decreased (0.25: 0.11 to 0.59).

Conclusions A higher percentage of playing time on an artificial turf was a risk factor for developing MT-5 in football players. This finding could be beneficial for creating strategies to prevent MT-5.

  • football
  • artificial turf
  • fifth metatarsal stress fracture

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  • Patient consent for publication Not required.

  • Contributors TM, MN, YS, HI, MY and KK developed the idea and designed this project. TM and MN managed the data. TM, MN and RS analysed the data. TM, MN and ST wrote the manuscript, and all authors reviewed the revised final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethicscommittee of the International University of Health and Welfare at Narita,Japan (number:16-Io-203).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All available data can be obtained by contacting the corresponding author.

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