[
]
research report
Journal of Orthopaedic & Sports Physical Therapy®
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Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Bing Yu, PhD1 • Jennifer J. Preston, MS2 • Robin M. Queen, PhD3 • Ian R. Byram, BA4 • W. Mack Hardaker, BS5
Michael T. Gross, PT, PhD6 • J. Marc Davis, PT, ATC-L7 • Timothy N. Taft, MD8 • William E. Garrett, MD, PhD9
Effects of Wearing Foot Orthosis With Medial Arch
Support on the Fifth Metatarsal Loading and Ankle
Inversion Angle in Selected Basketball Tasks
P
roximal fractures of the fifth metatarsal are most common
in young male athletes. These fractures are devastating to
athletes because they are slow to heal and have a high potential
for delayed union, nonunion, and refracture.4,9,14-19,26,28 These
fractures can be acute, stress, or combined acute/stress fractures of
the proximal portion of the fifth metatarsal. The Jones fracture4,8 was
first described by Jones in 190213 and involves the proximal third of
t Study Design: Preintervention and post­
intervention, repeated-measures experimental
design.
t Objectives: The objective was to investigate
the effects of foot orthoses with medial arch support on ankle inversion angle and plantar forces
and pressures on the fifth metatarsal during landing for a basketball lay-up and during the stance
phase of a shuttle run.
t Background: Proximal fractures of the fifth
metatarsal, specifically the Jones fracture, are
common in sports. Wearing foot orthoses with
medial arch support could increase the ankle inversion angle and the plantar forces and pressure
on the fifth metatarsal that may increase the risk
for fifth metatarsal fracture.
t Methods and Measures: Three-dimen-
sional (3-D) videographic, force plate, and in-shoe
plantar force and pressure data were collected
during landing after a basketball lay-up and during
the stance phase of a shuttle run with and without
foot orthoses with medial arch support for 14 male
subjects. Two-way ANOVAs with repeated measures were performed to compare ankle inversion
angle, maximum forces, and pressure on the fifth
metatarsal head and base between conditions and
between tasks.
t Results: The maximum ankle inversion
angle and maximum plantar force and pressure
on the base of the fifth metatarsal during both
tasks as well as the maximum plantar force and
pressure on the head of the fifth metatarsal during
the stance of the shuttle run were significantly
increased (P<.026) when wearing foot orthoses.
No significant differences were found in the maximum vertical ground reaction forces between foot
orthotic conditions.
t Conclusion: Generic use of off-the-shelf
foot orthoses with medial arch support causes
increased plantar forces and pressures on the fifth
metatarsal and may increase the risk for proximal
fracture of the fifth metatarsal. Future studies are
needed to investigate this risk, acknowledging that
the differences noted in our study were small in
magnitude and the foot type was not measured.
J Orthop Sports Phys Ther 2007;37(4):186-191.
doi:10.2519/jospt.2007.2327
t Key Words: fifth metatarsal fractures, foot
orthoses, in-shoe pressure, Jones fracture
the fifth metatarsal, distal to the insertion of the fibularis (peroneus) brevis
tendon, 1.5 cm from the tuberosity of
the fifth metatarsal (Figure 1).5,7,8,16,23
Jones described the mechanism of injury in vivid terms: “so powerful are the
ligaments that dislocation is rare. It is
obviously easier to break the bone than
to dislocate it.”13 The fifth metatarsal is
subjected to 3-point bending (Figure 1)
when the foot lands in a relatively inverted position. Forces are imposed at
the proximal end of the fifth metatarsal by the ground reaction force and
soft tissues such as the fibularis brevis,
lateral bands of the plantar fascia, and
ligamentous/capsular tissue between the
cuboid and the base of the fifth metatarsal. Force is also imposed by the ground
reaction force at the distal end of the
metatarsal as a result of the foot being
in a relatively inverted position. Finally,
the base of the fourth metatarsal applies
a force in response to the previously described forces, completing the 3-point
bending stress that may produce a stress
fracture in response to cumulative fatigue, an acute fracture following sufficiently high-magnitude loading, or a
combination of the two. Weight bearing
that occurs with the foot in an inverted
position, therefore, tends to promote the
Associate Professor, Center for Human Movement Science, Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, The University of North
Carolina at Chapel Hill, Chapel Hill, NC. 2 Graduate Student, Department of Biomedical Engineering, School of Medicine, The University of North Carolina at Chapel Hill, Chapel
Hill, NC. 3 Assistant Professor, Sports Medicine Center, Duke University, Durham, NC. 4 Medical Student, School of Medicine, The University of North Carolina at Chapel Hill,
Chapel Hill, NC. 5 Medical Student, School of Medicine, Duke University, Durham, NC. 6 Professor, Center for Human Movement Science, Division of Physical Therapy, Department
of Allied Health Science, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC. 7 Athletic Trainer, Department of Athletics, The University of North
Carolina at Chapel Hill, Chapel Hill, NC. 8 Professor, Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC. 9 Professor,
Sports Medicine Center, Duke University, Durham, NC. Address correspondence to Bing Yu, Center for Human Movement Science, Division of Physical Therapy, CB# 7135
Medical School Wing E, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7135. E-mail: byu@med.unc.edu
1
186 | april 2007 | volume 37 | number 4 | journal of orthopaedic & sports physical therapy
Journal of Orthopaedic & Sports Physical Therapy®
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previously described pattern of loading
within the fifth metatarsal.
Previous studies have demonstrated that basketball players have an increased prevalence of sustaining a fifth
metatarsal stress fracture compared to
other athletic populations.10,11 Speculation exists that the increased medial
support in modern basketball shoes may
be a contributing factor to the increased
incidence of a fifth metatarsal fracture.
Other factors in footwear design, such as
flexibility, cushioning, and fit, may also
have effects on the stresses being placed
on the fifth metatarsal during different athletic tasks. An understanding of
the loading characteristics of the fifth
metatarsal for selected athletic tasks frequently performed in basketball would
assist clinicians and sports shoe designers in understanding a possible mechanism of the Jones fracture, appropriately
prescribing foot orthoses, and improving
foot orthosis and sports shoe designs to
aid in preventing this type of fracture.
Foot orthoses are commonly used to
increase medial arch support in an attempt to control excessive pronation of
the foot. In addition, foot orthoses are
used for the prevention of plantar fasciitis and for controlling knee valgus/varus motion that may be associated with
patellofemoral injuries resulting from
malalignment of the lower extremity.12
Wearing foot orthoses with a medial arch
support, however, may increase ankle inversion angle and the stress imposed on
the fifth metatarsal, which may increase
the risk for Jones fracture. The purpose
of this study was to determine the effects of foot orthoses with medial arch
support on the ankle inversion angle and
the loading of the fifth metatarsal during
the landing after a simulated basketball
lay-up and during the stance phase of a
shuttle run. We hypothesized that wearing foot orthoses with a medial arch
support would increase maximum foot
inversion and contact forces and pressures imposed on the fifth metatarsal
during landing after the lay-up and during the stance phase of the shuttle run.
Soft
tissue
force
A
Fourth metatarsal
base reaction force
Ground
reaction force
Ground
reaction force
B
FIGURE 1. Three-point bending of the fifth metatarsal.
METHODS
F
ourteen healthy males between
18 and 30 years of age without a
known history of lower extremity injury and disorder, including a Jones fracture, were recruited as subjects for this
study. Each subject played competitive
basketball at least 3 times per week. Written consent, approved by the Biomedical
Institutional Review Board at the University of North Carolina at Chapel Hill, was
obtained from each subject prior to data
collection. Each subject’s body mass and
standing height were measured.
The tasks subjects performed in this
study were (1) a simulated basketball
lay-up that involved a single-leg landing, and (2) a shuttle run that involved a
maximum effort run forward followed by
a 180° change of direction and returning
to the original starting position. Both of
these tasks are commonly performed in
basketball. All subjects were provided the
same style of basketball shoe with a medium midsole stiffness (Nike, Inc, Beaverton, OR) for all testing. The 1st Step foot
orthosis (Wrymark, Inc, St Louis, MO)
was used for testing. The 1st Step foot orthosis is a noncustom semirigid medial
arch support insert similar to that used
in a previous study22 (Figure 2). The shoes
and foot orthoses were evaluated for each
subject for proper fit.
The 2 basketball-related tasks were
demonstrated by the investigators, and
the subjects were allowed to practice
the tasks until they were comfortable
performing them. The simulated lay-up
task consisted of an approach run of 3 to
4 steps, followed by a single-leg takeoff
C
D
FIGURE 2. Foot orthosis with medial arch support used
in this study: (A) superior view, (B) inferior view, (C)
medial view, and (D) rear view.
for maximum height, and a single-leg
landing. Subjects were encouraged to
use their arms to simulate shooting the
ball toward the basketball rim during
this task. Each subject was asked to use
the same leg for the takeoff and landing.
The shuttle run task consisted of running
forward approximately 2 m as quickly as
possible, planting the landing foot, and
doing a 180° turn with the plant foot on
the force plate, and running back to the
starting position. The dominant lower extremity was used in both tasks. The dominant lower extremity was defined as the
lower extremity used for single-leg jump.
The foot was planted approximately 90°
from the running direction during the
stance phase of the shuttle run. Warm-up
for both tasks included having the subjects practice the motion until they felt
comfortable repeating the motion for the
trials and made appropriate contact with
the force plates.
A pressure sensitive insole (Novel, Inc,
St Paul, MN) was placed in the basketball
shoe and on top of the foot orthoses for
the dominant lower extremity only. The
pressure sensitive insoles are approximately the same thickness as a typical
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187
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[
basketball shoe insole. Each of the pressure insoles contains 99 sensors used to
monitor plantar pressure distribution.
Passive reflective markers were placed
on each of the subject’s legs at the medial
and lateral tibial condyles, the anterior
and proximal aspects of the tibia, and on
the shoe over the heel, on the head of the
first and fifth metatarsals, and over the
medial and lateral malleoli. The same
lower extremity was instrumented for
both movement conditions and was the
lower extremity used for pivoting during
the shuttle run and landing after the layup. Each subject performed 5 successful
trials of the lay-up task and 5 successful
trials of the shuttle run for each of the 2
foot orthotic conditions (with and without foot orthoses). A successful trial was
defined as the trial in which the subject
completed the task as required while all
data were collected. The order of the 2
foot orthotic conditions was randomized
for each subject.
Three-dimensional coordinates of
the reflective markers and ground reaction force data were collected using
Motus real-time 3-D videographic and
analog data acquisition system (Peak
Performance Technologies, Englewood,
CO) with 6 infrared video cameras and
2 Bertec 4060A force plates (Bertec,
Worthington, OH) at 120 frames/second, and 1200 samples/channel/second, respectively. The in-shoe plantar
force and pressure data were collected
using the Pedar pressure data acquisition system (Novel, Inc, St Paul, MN) at
200 samples/sensor/second. The videographic and ground reaction force data
collections were time synchronized by
the Motus videographic and analog data
acquisition system. The insole pressure
data were time-synchronized with videographic and ground reaction force data
after data collection by matching the
initial foot contact time. The initial foot
contact time was defined as the time of
the last sample in which the ground reaction force was zero after the data acquisition programs were activated.
The 3-D coordinates of the reflective
research report
markers were filtered through a fourth-order Butterworth low-pass digital filter at
estimated optimum cutoff frequencies.27
The ankle joint angles were calculated
as the Euler angles of the shoe reference
frame relative to the lower leg segment
reference frame with the plantar flexion/
dorsiflexion (z-axis), inversion/eversion
(y-axis), and toe-in/toe-out (x-axis) as the
first, second, and third rotation, respectively. The ground reaction force signals
from the 2 force plates were combined to
determine the total ground reaction forces
on the landing foot in each trial. The magnitudes of ground reaction forces were
normalized to each subject’s body weight.
The sensors under the head and the
base of the fifth metatarsal were identified before data collection while the subject was standing on the pressure sensor
insole. The force on each sensor was calculated as the product of the pressure
measured by the sensor and the area of
the sensor. Total plantar forces and pressures were computed for the head or base
of the fifth metatarsal. The total plantar
force on the head or base of the fifth
metatarsal at a given time was calculated
as the sum of the forces on all the sensors
under the head or base of the fifth metatarsal at a given time. The plantar pressure on the fifth metatarsal head or base
at a given time was calculated as the total
plantar force on the head or base of the
fifth metatarsal at the given time, divided
by the total areas of the sensors under the
head or base of the fifth metatarsal. Finally, the plantar forces on the head or
base of the fifth metatarsal were normalized to each subject’s body weight.
The first 3 analyzable trials of each
subject in each task under each condition were used for statistical analysis.
An analyzable trial was defined as a
trial in which all the data were successfully collected and processed. Maximum
ankle joint inversion angle, peak vertical
ground reaction force, and plantar forces
and pressures on the head and base of the
fifth metatarsal were identified for each
subject in each trial of each task under
each foot orthotic condition, and used
]
as dependent variables for data analysis.
Two-way analyses of variance (ANOVA)
with repeated measures were performed
to determine the effects of task (landing
after the lay-up and stance of the shuttle
run) and foot orthotic condition (with and
without foot orthoses) on each dependent
variable. A total of 168 trials were entered
into each 2-way ANOVA model. Each
ANOVA model had task and orthotic
condition as 2 fixed factors, the interaction of task by condition, and random
effects of subject nested by task, subject
nested by condition, and subject nested
by condition by task. The random effect
of subject nested by task by condition was
used as the error term in the evaluation of
the interaction of task by condition. The
random effect of subject by condition was
used as the error term in evaluation of the
effect of condition. The random effect of
subject by task was used as the error term
in evaluation of the effect of task. Oneway ANOVAs with repeated measures
were performed to determine the foot
orthosis effect in each task and task effect
in each orthotic condition in a situation
when a significant interaction effect of
orthotic condition and task was detected.
A type I error rate of 0.05 was chosen to
indicate statistical significance.
RESULTS
T
he condition and task had no
significant interaction effect on the
maximum ankle inversion angle (P
= .890). The maximum ankle inversion
angle during the landing of the lay-up
and during the stance of the shuttle run
was significantly increased in the trials
when the subjects wore the foot orthoses
compared to the trials when the subjects
did not wear the foot orthoses (P = .010)
(Tables 1 and 2). The maximum ankle
inversion angle during the 2 tasks was
increased by an average of 2.5° across
subjects with the foot orthoses. The maximum ankle inversion angle was also significantly greater during the stance of the
shuttle run than during the landing of the
lay-up (P,.001) (Tables 1 and 2).
188 | april 2007 | volume 37 | number 4 | journal of orthopaedic & sports physical therapy
TABLE 1
Summary Statistics for Landing of the Basketball
Lay-up Between Foot Orthosis Conditions
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Variable
Mean (SD)
Without Orthosis
Mean (SD)
MeanLower 95%Upper 95%
With OrthosisDifference (SD)Confidence IntervalConfidence Interval
P Value
Maximum ankle inversion angle (deg)
11.02 (8.73)
13.84 (9.19)
2.83 (1.66)
1.66
3.69
.010
Maximum vertical ground reaction force (BW)
4.07 (0.67)
4.06 (0.76)
–0.01 (0.56)
–0.30
0.29
.641
Maximum plantar force on fifth metatarsal head (BW)
Maximum plantar pressure on fifth metatarsal head (kPa)
Maximum plantar force on fifth metatarsal base (BW)
Maximum plantar pressure on fifth metatarsal base (kPa)
0.51 (0.11)
0.45 (0.14)
–0.05 (0.12)
–0.12
0.01
.081
170.57 (37.08)
152.85 (47.07)
–17.72 (39.78)
–38.56
3.12
.062
0.43 (0.15)
0.46 (0.14)
0.03 (0.04)
0.01
0.05
.023
189.93 (61.23)
199.16 (60.65)
9.23 (17.43)
0.10
18.36
.026
Summary Statistics for the Stance Phase
Shuttle Run Between Foot Orthosis Conditions
TABLE 2
Variable
Mean (SD)
Without Orthosis
Maximum ankle inversion angle (deg)
42.37 (7.01)
Mean (SD)
MeanLower 95%Upper 95%
With OrthosisDifference (SD)Confidence IntervalConfidence Interval
P Value
44.51 (6.46)
2.15 (3.36)
0.07
4.22
.010
Maximum vertical ground reaction force (BW)
1.83 (0.40)
1.73 (0.29)
–0.10 (0.22)
–0.21
0.02
.641
Maximum plantar force on fifth metatarsal head (BW)
0.24 (0.11)
0.30 (0.12)
0.06 (0.12)
0.03
0.09
.003
80.68 (40.00)
102.16 (44.32)
21.47 (20.09)
10.95
32.00
.003
Maximum plantar force on fifth metatarsal base (BW)
0.08 (0.05)
0.11 (0.03)
0.03 (0.04)
0.01
0.05
.023
Maximum plantar pressure on fifth metatarsal base (kPa)
37.18 (20.84)
49.92 (15.47)
12.74 (15.65)
4.45
20.93
.026
Maximum plantar pressure on fifth metatarsal head (kPa)
The condition and task had no significant interaction effect on the peak
vertical ground reaction force (P = .788).
The maximum vertical ground reaction
force was significantly greater during the
landing after the lay-up than during the
stance phase of the shuttle run (P,.001)
(Tables 1 and 2). The foot orthosis had
no significant effect on the peak vertical
ground reaction force in both tasks (P =
.641) (Tables 1 and 2).
The condition and task had a significant
interaction effect on the maximum plantar force and pressure on the head of the
fifth metatarsal (P,.001). The maximum
plantar force and pressure on the head
of the fifth metatarsal were significantly
greater during the landing after the lay-up
than during the stance of the shuttle run
(P,.001) (Tables 1 and 2). The maximum
plantar force and pressure on the head of
the fifth metatarsal during the stance of
the shuttle run were significantly greater
in the trials when the subjects wore the
foot orthoses compared to the trials when
the subjects did not wear foot orthoses (P =
.003) (Table 2). The orthotic condition had
no significant effect on the maximum plan-
tar force and pressure on the head of the
fifth metatarsal during the landing after
the lay-up (P = .081, P = .062) (Table 1).
Condition and task had no significant
effect on the maximum plantar force and
pressure on the base of the fifth metatarsal (P = .794). The maximum plantar
force and pressure on the base of the fifth
metatarsal during the landing after the
lay-up and during the stance of the shuttle run were significantly increased in
the trials when the subject wore the foot
orthoses, compared to the trials when
the subjects did not wear foot orthoses
(P = .023, P = .026) (Tables 1 and 2). The
maximum plantar force and pressure on
the base of the fifth metatarsal were significantly greater during the landing of
the lay-up than during the stance of the
shuttle run (P,.001).
DISCUSSION
T
he purpose of this study was to
determine the effects of off-theshelf orthoses with a medial arch
support on ankle joint kinematics, kinetics, and the plantar forces and pressures
on the fifth metatarsal during 2 tasks
frequently performed while playing
basketball. We hypothesized that wearing foot orthoses with a medial arch support would increase the maximum ankle
inversion angle and thus increase the
plantar force and pressure on the head
and the base of the fifth metatarsal during the landing of the lay-up and during
the stance of the shuttle run. The results
of this study show that wearing foot orthoses with a medial arch support significantly increased the maximum ankle
inversion angle during the landing of
the lay-up and the stance of the shuttle
run. Also, the results show that wearing
foot orthoses with a medial arch support significantly increased maximum
plantar forces and pressures on the head
and base of the fifth metatarsal during
the landing of the lay-up and the stance
of the shuttle run. Further, the results
show that wearing foot orthoses did not
significantly affect maximum vertical
ground reaction force, which suggests
that the differences in the plantar forces
and pressures on the fifth metatarsal between foot orthotic conditions were not
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189
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[
due to the alteration of performance.
These results combined together support
our hypothesis that wearing foot orthoses with a medial arch support increases
maximum ankle inversion, which shifts
the plantar force and pressure distribution on the foot laterally and anteriorly,
thus increases the plantar forces and
pressures on the fifth metatarsal for the
2 selected basketball-related tasks.
Use of certain athletic shoes and orthoses with medial wedging, therefore,
may result in increased ankle inversion
at initial foot contact with the ground to
produce repetitive 3-point bending of the
fifth metatarsal (Figure 1). This pattern of
loading may contribute to create cumulative fatigue of the proximal portion of this
bone. This scenario could, theoretically,
predispose an individual to stress fracture, acute fracture, or combined stress/
acute fracture. Future studies are needed
to investigate this possibility, considering
that the differences we noted, although
statistically significant, were small in
magnitude. Clinicians should be aware
of the potential for this type of injury
and monitor closely athletes who are using shoe-orthotic combinations that may
result in this pattern of loading.
The results of this study were consistent with previous reports in the literature. Burgess et al3 studied the influence
of a small insert in the footbed of a shoe
on plantar pressure distributions. They
reported that the small insert significantly shifted the peak pressures towards
the head of the fifth metatarsal. Allard et
al1 and Stokes et al24 estimated that the
maximum load on the fifth metatarsal
during walking was about 50 N. Arangio
et al2 estimated that the maximum force
acting on the head of the fifth metatarsal could be over 100 N. The maximum
loading on the fifth metatarsal observed
in this study during the stance of the
shuttle run was approximately 200 N.
The difference between the force on the
head of the fifth metatarsal reported by
Arangio et al2 and our results may be
attributable to the difference in tasks,
similar to the difference in the vertical
research report
ground reaction forces between walking
and running. Stacoff et al20 studied the
effects of foot orthoses with medial arch
support and medial calcaneus support on
skeletal motion during running. The foot
orthoses with medial arch support used
by Stacoff et al20 were similar to those
used in the present study. Stacoff et al22
reported that the orthoses reduced maximum ankle eversion by 1° to 3°. Although
these investigators measured maximum
eversion and we measured maximum
ankle inversion, the studies together indicate that use of these foot orthoses tends
to bias the rearfoot into a more inverted
position during stance.
Although wearing foot orthoses with a
medial arch support increased the plantar forces and pressures on the fifth metatarsal by approximately 20% during the
stance of the shuttle run in this study, the
effects of this foot orthosis on inversion
angle and forces and pressures under the
fifth metatarsal may vary depending on
individual characteristics, such as arch
height, resting calcaneal inversion, or
other foot characteristics. Arch height
and other foot type characteristics, however, were not measured for our subjects
and the foot orthosis was not customized
to the arch height and other foot type
characteristics for each subject. The actual medial arch support provided by the
foot orthoses, therefore, varied among
subjects. Additional studies are needed
to investigate the effects of noncustom
foot orthoses, custom foot orthoses, and
foot type on inversion/eversion kinematics and plantar pressures.
The ankle inversion angles measured
in this study should be viewed with caution. The foot and tibia segment reference frames also were determined from
the locations of the external markers
on the shoes and tibia. The ankle joint
angles were then determined from the
orientation of the shoe reference frame
relative to the tibial reference frame. The
calculated ankle joint angles were actually the angles between the basketball
shoe and the tibia, instead of the angles
between the foot and the tibia, and may
]
not be accurate representations of actual
ankle angles because of foot movements
relative to the shoe. Although the effect of
foot orthosis on the ankle inversion angle
is consistent with the literature, the observed mean increase in ankle inversion
angle is within the range of relative movement between the shoe and foot about the
ankle inversion/eversion axis.6,21,22,25 Also,
we calculated the ankle inversion angle
instead of a supination angle, which is a
combination of foot inversion, adduction,
and plantar flexion.
Force and pressures imposed on the
head of the fifth metatarsal during the
stance of the shuttle run and during cutting tasks may need further examination. Arangio et al2 estimated that the
load on the head of the fifth metatarsal
was below the maximum allowable loading. The estimated submaximal loading on the head of the fifth metatarsal
during functional activities provides
additional evidence that the fifth metatarsal fracture is indeed a stress fracture.
Our literature review revealed that fifth
metatarsal fractures frequently occur in
basketball games and practices in which
the shuttle run and cutting tasks were
frequently performed.18,26 This information suggests that repeated loading of
the head and base of the fifth metatarsal
during the stance of the shuttle run and
cutting tasks may be related to fracture of
the fifth metatarsal, and should be closely
examined in future studies.
Forces and pressures imposed on
the lateral aspect of the fifth metatarsal
should also be examined in future studies. Only the forces and pressures on the
plantar aspect of the foot were measured
in this study. Considering the orientation
of the fifth metatarsal relative to the sole,
the inversion/eversion motion of the foot,
and the possible relative movements between the sole and foot during the tasks
tested in this study, the insole forces and
pressures measured in this study are
perpendicular to the sole but not necessarily perpendicular to the plantar plane
of the foot. These forces and pressures,
however, should have a large projection
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to the fifth metatarsal adduction/abduction plane, and thus are relevant measures of the risk for fifth metatarsal stress
fracture. The measurement of forces and
pressures on the lateral side of the fifth
metatarsal, however, may provide a more
comprehensive view of the loading on the
fifth metatarsal and improve our understanding of risk factors for fifth metatarsal stress fractures.
The potential interaction effects of
shoes and foot orthoses should also be
examined in future studies. Only 1 type of
basketball shoe was tested in this study.
The effects of noncustom foot orthoses on
the fifth metatarsal loading found in this
study may not be representative of the
general effects of foot orthoses for different types of basketball shoes or different
types of feet.
CONCLUSIONS
W
earing noncustomized offthe-shelf foot orthoses with medial arch support significantly
increases maximum ankle inversion angle
during the landing after the basketball
lay-up and during the stance of the shuttle run. Wearing the noncustomized offthe-shelf foot orthoses with medial arch
support also significantly increases maximum pressures and forces on the base of
the fifth metatarsal during the landing of
the lay-up, and on the head and base of
the fifth metatarsal during the stance of
the shuttle run while having no significant
effect on the maximum vertical ground reaction force.
Generic use of noncustomized offthe-shelf foot orthoses with medial
arch support may increase the risk of
increasing fifth metatarsal loading and
fractures. Future studies are needed to
investigate this risk, acknowledging that
the differences noted in our study were
small in magnitude and the foot type
was not measured.
ACKNOWLEDGEMENT
This study was supported by a research
grant from Nike Sports Research Laboratory. t
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