Background: The literature shows an anecdotal relationship between high-arched feet and proximal fifth metatarsal stress fractures. This relationship has never been supported by sound scientific evidence. Our aim in this study was to examine whether athletes sustaining this injury are characterized by a static foot structure or a dynamic loading pattern during stance.

Materials and Methods: Ten professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control uninjured soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation during stance. Each variable was compared between injured and uninjured feet.

Results: Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation during stance revealed relative unloading of the fourth metatarsal in both the injured and sound limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes.

Conclusion: Athletes who sustain proximal fifth metatarsal stress fracture are not characterized by an exceptional static foot structure. Dynamically lateral metatarsal unloading during the stance phase may either play a role in the pathogenesis of the injury, or alternatively represent an adaptive process.

Clinical Relevance: Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics.

Non union of long bone remains a dreadful complication.

The introduction of new strategies for orthopaedic surgeons to control and modulate bone healing using growth factors such as bone morphogenetic proteins (BMP) have been shown to induce bone formation and union in long bone defects and non unions.

A recombinant form of BMP (BMP-2) is FDA approved to promote fracture healing in tibial non unions.

The study aim was the assessment of the safety and efficacy of a single dose of recombinant human bone morphogenetic protein-2 (INDUCTOS^®) combined with bank bone on the rate of bone formation and union in long bone defects and non unions.

Since October 2005, 44 patients (28 men, 16 women) with a median age of 41.81 (range: 14–78) received a single dose of BMP-2 (INDUCTOS^®) in an extensive segmental long bone defects (mean score: 31.7 cc +/− 63.2; range: 5–261) in combination with bone bank graft (chips or cancellous bone blocs), without any adjunct of autologous bone or bone marrow. The series included 12 femur, 24 tibia, 5 radius/ulna, 3 humerus. All fractures were stabilised using external or internal fixation (mostly Ilizarov). All cases are available for complete follow-up.

Assessment of fusion was performed using digital radiographs at postoperative time, at 10 to 15 days and 1, 2, 3 month and every month till healing. Outcomes of the defects were evaluated using the Imagika^® software.

Clinical stabilisation of the diaphyseal non unions, restoration of the limb length and axis, solid bone fusion were observed in all but two patients within a median time of 6.1 +/− 3.0 months (range: 2.5–15.0).

We observed that BMP-2 induced bone formation across the defect; radiographs showed rapid ossification, with bone graft densification and margin’s shadings.

With no need for donor sites, BMP restored the continuity and stability of critical-size defects faster than what we had observed in our former practice using large amounts of autograft combined with bank bone when necessary. We believe that this procedure provide faster healing, give more comfort and less sequel to patients.