Awareness of fifth metatarsal stress fractures among soccer coaches in Japan: A cross-sectional study

Although a fifth metatarsal stress fracture is the most frequent stress fracture in soccer players, awareness of fifth metatarsal stress fractures among soccer coaches is unclear. Therefore, we performed an online survey of soccer coaches affiliated with the Japan Football Association to assess their awareness of fifth metatarsal stress fractures. A total of 150 soccer coaches were invited for an original online survey. Data on participants’ age, sex, types of coaching licence, coaching category, types of training surface, awareness of fifth metatarsal stress fractures, and measures employed to prevent fifth metatarsal stress fractures were collected using the survey. Data from 117 coaches were analysed. Eighty-seven of the 117 coaches were aware of fifth metatarsal stress fractures; however, only 30% reported awareness of preventive and treatment measures for fifth metatarsal stress fractures. Licensed coaches (i.e., licensed higher than level C) were also more likely to be aware of fifth metatarsal stress fractures than unlicensed coaches were. Furthermore, although playing on artificial turf is an established risk factor for numerous sports injuries, soccer coaches who usually trained on artificial turf were more likely to be unaware of the risks associated with fifth metatarsal stress fractures than coaches who trained on other surfaces were (e.g., clay fields). Soccer coaches in the study population were generally aware of fifth metatarsal stress fractures; however, most were unaware of specific treatment or preventive training strategies for fifth metatarsal stress fractures. Additionally, coaches who practised on artificial turf were not well educated on fifth metatarsal stress fractures. Our findings suggest the need for increased awareness of fifth metatarsal stress fractures and improved education of soccer coaches regarding injury prevention strategies.　

Methods
A computer-based survey was created following a literature review of the injury, treatment, and prevention of MT-5 and a discussion with experienced physical therapists, sports medicine physicians, and sports scientists who were familiar with MT-5. The final version of the questionnaire was established through consensus among all members to encompass all relevant aspects of MT-5. This study’s main interest was to understand differences in the awareness about the injury, treatment, and prevention of MT-5 by licence level and coaching environment. Hence, the questionnaire was designed with an emphasis on how many coaches were aware of this information rather than the depth of their knowledge of MT-5. A research request was sent to potential respondents who provided consent. Each participant entered the mobile terminal using a personalised code. The exclusion criteria were failure to provide informed consent to complete the survey. Additionally, if more than one incomplete response in the questionnaire was confirmed, all the individual’s data were excluded from the analysis.