Navicular stress fracture injury: observational use of plantar pressure measures in elite AFL footballers

Abstract

Background Navicular stress fracture (NSF) is a relatively uncommon injury according to Australian Rules Football (AFL) injury surveillance data. Like all stress fractures, a disproportionate amount of compression / strain (dose) versus remodeling (response) accounts for bone breakdown. The exact mechanism of injury or anthropometric factors involved in navicular stress fracture remains largely unknown however; several authors speculate a short first metatarsal and metatarsus adductus as contributing factors. It is thought that a long second metatarsal transmits forces unevenly through the medial cuneiform creating shearing stress at the avascular central zone of the navicular. To date no prospective data is available to support these theories. Navicular stress fracture is deemed high risk due to the potential of delayed or non union and often excessive time away from activity. Methods Retrospective plantar pressure mapping of two elite AFL footballers who’d sustained NSF injury were recorded. Testing involved unshod across a floor mounted pressure sensing mat (EMED SF™, Novel Munich Germany) using a two-step method following familiarisation. Five (5) trials were performed for each foot with the averages of the middle three (3) trials used for further analyses. Subsequent testing using an in-shoe pressure mapping system, (EMED ™ Pedar,Novel Munich Germany) was performed with custom moulded foot orthoses in situ. Data from twenty (20) steps were recorded, allowing for acceleration and deceleration with the middle ten (10) steps used for further analyses. Computer software generated data for Peak Pressure across 10 masked areas (kPa), Instant to Peak Pressure (ms), Contact Area (cm 2 ), Force and Pres