Risk factors of metatarsal stress fracture associated with repetitive sports activities: a systematic review.

Metatarsal stress fractures show up often in athletes and military recruits who put repeated load through the foot, and understanding why some people develop them has been difficult because the research has come from many different angles. This review pulled together 32 studies spanning four decades to look at what anatomical, biomechanical, and sports-related factors keep appearing as risk factors. The broad picture that emerged is a mix of foot shape and movement patterns, such as higher arches and abnormal inward or outward rolling of the foot, alongside sport-specific patterns, where soccer players tend toward fifth metatarsal fractures while runners and recruits more often fracture the second or third metatarsal. Training intensity, sudden changes in training, and inadequate footwear also featured as contributors.

The authors are clear that measurement methods across studies were not standardized and the included research was quite varied, so these associations should be read as suggestive patterns rather than settled risk profiles.

If you run long distances, play soccer, or are going through recruit training, you may have wondered why some people develop stress fractures in the small bones of the foot called metatarsals while others doing similar activity don't. This review gathered findings from 32 existing studies to look at what factors tend to show up alongside these fractures. The overall pattern suggests that foot shape, including having a higher arch, and the way the foot rolls inward or outward during movement, are linked to fracture risk, though there is no single standard way researchers have measured these features.

Which metatarsal breaks also seems to depend on the sport, soccer players more often fracture the fifth metatarsal, while runners and recruits tend toward the second or third. Training load, sudden changes in training, and footwear were mentioned as contributing factors as well.

Because the underlying studies used different methods and populations, these are associations rather than proven causes, and the review's authors urge caution in how firmly these patterns should be interpreted.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians trying to make sense of who is vulnerable to metatarsal stress fracture and why, this systematic review synthesises 32 studies published between 1984 and 2024 examining anatomical, biomechanical, and sport-related risk factors. It does not report new primary data but consolidates existing observational findings, so it should be read as a map of associations rather than a test of any single risk factor's causal contribution. The review highlights that higher foot arch, abnormal foot inversion or eversion, and certain metatarsal length or angle characteristics recur across studies as associated with fracture risk, though the authors explicitly note the absence of standardized measurement protocols across these anatomical assessments, which limits direct comparison between studies.

Sport-specific fracture location patterns were also identified, with soccer linked to fifth metatarsal fractures and long-distance running or recruit training linked to second or third metatarsal fractures, alongside training-related factors like high intensity, non-adaptive programming, and inadequate equipment. The central limitation carried through the abstract is substantial heterogeneity and inherent bias across the included studies, meaning findings should inform hypothesis generation and individualised assessment thinking rather than support a standardized screening protocol or definitive causal claims about any one anatomical or training factor.