Abstract
BackgroundMetatarsal fractures, especially of the fifth metatarsal, are common injuries of the foot in a young athletic population, but the risk factors for this injury are not well understood. Dual-energy x-ray absorptiometry (DXA) provides reliable measures of regional bone mineral density to predict fracture risk in the hip and lumbar spine. Recently, sub-regional metatarsal reliability was established in fresh cadaveric specimens and associated with ultimate fracture force. The purpose of this study was to assess the reliability of DXA bone mineral density measurements of sub-regions of the second and fifth metatarsals in a young, active population.MethodsThirty two recreationally active individuals participated in the study, and the bone density of the second (2MT) and fifth (5MT) metatarsals of each subject was measured using a Hologic QDR x-ray bone densitometer. Scans were analyzed separately by two raters, and regional bone mineral density, bone mineral content, and area measurements were calculated for the proximal, shaft, and distal regions of the bone. Intra-rater, inter-rater, and scan-rescan reliability were then determined for each region.ResultsProximal and shaft bone mineral density measurements of the second and fifth metatarsal were reliable. ICC’s were variable across regions and metatarsals, with the distal region being the poorest.ConclusionsBone mineral density measurements of the metatarsals may be a better indicator of fracture risk of the metatarsals than whole body measurements. A reliable method for measuring the regional bone mineral densities of the metatarsals was found. However, inter-rater reliability and scan-rescan reliability for the distal regions were poor. Future research should examine the relationship between DXA bone mineral density measurements and fracture risk at the metatarsals.
Highlights
Metatarsal fractures, especially of the fifth metatarsal, are common injuries of the foot in a young athletic population, but the risk factors for this injury are not well understood
The distribution of injuries across the metatarsals can vary within different populations
Many epidemiological studies do not discriminate between metatarsal fractures and foot injuries, with most focusing solely on one specific metatarsal
Summary
Metatarsal fractures, especially of the fifth metatarsal, are common injuries of the foot in a young athletic population, but the risk factors for this injury are not well understood. The purpose of this study was to assess the reliability of DXA bone mineral density measurements of sub-regions of the second and fifth metatarsals in a young, active population. Many epidemiological studies do not discriminate between metatarsal fractures and foot injuries, with most focusing solely on one specific metatarsal. Healing times for these injuries can Pritchard et al Journal of Foot and Ankle Research (2017) 10:52. Similar to the second metatarsal, fractures to the proximal fifth metatarsal can have an increased impact on individuals, especially athletes [6]. Athletes may be forced to miss half, or even a whole season of competition after experiencing a proximal fifth metatarsal fracture [6]
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