Soccer is rough on the feet! Soccer players are prone to foot and ankle injuries from running, jumping, cutting, contacting players, and striking the soccer ball. While we often see soccer players with ankle sprains of the ligaments, fractures are a significant cause for concern. Knowing the signs and symptoms of a fracture can help determine if an injury was sustained, and if an athlete needs to be held out of sport and seek medical treatment.
Stress fractures occur due to overuse and repetitive activity in running sports, especially soccer. A stress fracture is a small break or crack in a bone, or significant bruising within a bone. Stress fractures often occur at the second and third metatarsals, which are the site of heavy impact during weight-bearing activities. The repetitive stress of walking and running ultimately leads to the “wearing down” of bone. Bones naturally undergo a remodeling process in which new bone develops and replaces older bone. However, vigorous athletic activity may cause the bone to break down at a faster rate, outpacing the body’s natural ability to repair and ultimately causing a stress fracture over time.
- Bone insufficiency (Vitamin D)
- Poor athletic conditioning
- Improper technique during sport
- Change in surface (transitioning from flat turf to grassy field)
- Improper footwear (flimsy, no support)
- Pain that decreases with rest
- Pain that occurs and worsens with normal daily activities
- Swelling at top of foot/outside of ankle
- Tenderness to touch at fracture site
- Possible bruising
Traumatic fractures frequently occur at the ankle bones (tibia, fibula) during high impact sports; however, traumatic metatarsal fractures are also common. Metatarsal fractures are caused by a direct blow or impact to the foot—either from being stepped on, kicking or being kicked, or spraining the ankle. Traumatic fractures can be considered either displaced or nondisplaced, with displaced fractures typically requiring more advanced medical attention.
Two types of fractures typically associated with soccer include avulsion fractures and Jones fractures. Avulsion fractures occur when a small piece of bone is pulled off the larger bone by a ligament or tendon. This usually occurs when the ankle rolls into an inverted position, and is often associated with an ankle sprain. Jones fractures occur at the base of the fifth metatarsal, where there is normally less blood supply. This area is susceptible to delays in healing and is more difficult to treat than an avulsion fracture.
Symptoms of Traumatic Fracture:
- Audible sound at time of break
- Pinpoint pain at time fracture occurs until a few hours later
- Abnormal appearance of toes, foot
- Difficulty walking
- Bruising/swelling of foot
Symptoms of Jones Fracture:
- Pain, tenderness at outside of foot
- Swelling at outside of foot
- Difficulty walking
Athletes experiencing persistent pain should cease playing and seek medical advice to rule out a fracture. Stress fractures typically take a few weeks to show up on x-ray imaging due to their tiny size. Your orthopedist may recommend a bone scan or MRI if they suspect a stress fracture, with follow up x-rays showing callus formation at the fracture site. Bony fractures typically take 6-8 weeks to heal. Injured athletes should rest, ice, and elevate the affected leg for 20 minutes per hour to reduce pain and swelling. Consult with a medical professional regarding any injuries.
- AAOS (2015). Stress Fractures of the Foot and Ankle. OrthoInfo.AAOS.org. Retrieved at: https://orthoinfo.aaos.org/en/diseases–conditions/stress-fractures-of-the-foot-and-ankle/.
- ACFAS (2019). Fractures of the Fifth Metatarsal. FootHealthFacts.org. Retrieved at: https://www.foothealthfacts.org/conditions/fractures-of-the-fifth-metatarsal.
- ACFAS (2019). Toe and Metatarsal Fractures. FootHealthFacts.org. Retrieved at: https://www.foothealthfacts.org/conditions/toe-and-metatarsal-fractures-(broken-toes).
- Rammelt, S., Haineck, J., & Zwipp, H. (2004). Metatarsal Fractures. Injury (35, 2: 77-86). Retrieved at: https://www.ncbi.nlm.nih.gov/pubmed/15315882.
Christina Gioeli, PT, DPT
Clinic Director, EXCEL Berkeley Heights
Christina graduated magna cum laude from the CUNY Macaulay Honors College at the College of Staten Island in 2013 with a Bachelor of Science in Psychology Honors. She continued on at the College of Staten Island to receive her Doctorate of Physical Therapy in 2016. While studying for both degrees, Christina worked as a physical therapist aide in an outpatient orthopedic setting, working closely with many physical therapists. Her education through CSI and in outpatient facilities offered vast experience treating many patient populations, with an emphasis on manual therapy and orthopedics.