Biomechanical Variables Associated with Tibial and Third Metatarsal Stress Fractures in Royal Marines Recruits

Abstract

Due to their prevalence and associated high rehabilitation costs, this thesis aimed to better understand factors influencing the risk of tibial (TSF) and third metatarsal (MT3SF) stress fractures in Royal Marine recruit training. In Study 1, the standard issue combat assault boot and neutral trainer were assessed during running. Running in the boot caused restricted ankle motion, greater forefoot loading, greater ankle stiffness and a more laterally applied horizontal force vector at the instant of peak braking, suggesting that the risk of incurring MT3SF was greater in this condition. In Study 2, bending stresses were modelled along the length of the third metatarsal of five participants, using individual bone geometry and dynamic gait data. Stresses were modelled for running when barefoot, and when shod in the standard issue footwear. Estimated peak bending stresses were significantly greater in the combat assault boot than the gym trainer, predominantly due to increased plantar loading. Individual bone geometry was however dominant in determining peak bending stresses. In Study 3, a large (n=1065) prospective study was conducted to identify differences in baseline characteristics between recruits sustaining a TSF or MT3SF and those who complete training uninjured. Ten TSF and 14 MT3SF cases were compared to 120 uninjured legs. Results suggest that risk of TSF is greater in those recruits with reduced ability to resist loading and attenuate impact during gait. Results for MT3SF suggest that ankle and foot position at touchdown, and the timing and magnitude of forefoot loading, are important factors influencing risk of this injury. The observation of lower age and BMI in both stress fracture groups was linked to lower bone strength and earlier fatigue mechanisms. This thesis has increased the understanding of MT3SF in particular, and provides information on specific factors which may be associated with MT3SF and TSF in RM recruits during basic training.