Metatarsal Fractures In Elite Soccer Players

An England World Cup preparation wouldnt be complete without one of its star players suffering from a metatarsal fracture, only weeks before the start of the tournament! David Beckham was the first victim of the much dreaded injury in 2002, and in 2006, Wayne Rooney topped most of the newspapers with the same injury. This time, it was John Terrys turn, or so we feared.

Thankfully things werent as bad as they originally seemed, and John Terry will still be present in South Africa, leading Englands defence.

So what exactly is a broken metatarsal and why do we seem to hear so much about it these days more than we ever have done in the past?

Before we identify why, lets take a closer look at the metatarsal bones first.

The bones between the ankle and the toes are called the metatarsal bones. The first metatarsal is located on the inside of the foot, and connects the ankle with the big toe, whereas the fifth metatarsal bone is located on the outside of the foot and connects the ankle with the little toe.

The two main functions of the feet are to propel and to support. The metatarsals play a major role in these two functions. By acting like a rigid lever to aid propulsion, they manage to increase our efficiency whilst walking or running. Additionally, they act like a flexible structure to aid and support balance to cope with uneven ground.

The second, third and fourth and fifth metatarsal bones are usually injured as a result of a prolonged period of overuse, creating something we call a stress fracture. A stress fracture is an incomplete fracture in the bone. It could be described as a very small sliver or crack in the bone. These types of fractures are also known as hairline fractures. These kinds of fractures are common with athletes, soldiers, and ballet dancers.

Another common cause for metatarsal fractures is direct trauma i.e. a direct kick to the sole of the opponents boot. This typically affects the first metatarsal bone.

One of the reason why the foot is so susceptible to fractures is that is very few muscles and fat protecting the foot from any impact.

The initial therapy with a broken metatarsal bone is to rest it, absolutely no exercise for 4 to 8 weeks. The recovery time of the injury is determined by the extent of the damage and which of the five metatarsal bones is affected.
Walking boots or shoes with very stiff soles may be advised for the player to wear in order to protect the fracture while it heals. If the fracture was caused by overuse and not by direct trauma, the athletes training habits, equipment and running technique should all be investigated and possibly adapted.

Putting a time scale on the recovery of a stress fracture is very difficult as the following examples of recovery times show. Michael Owen, broke his fifth metatarsal in 2006, was predicted to return in 6 to 8 weeks, but finally made his return 17 weeks later. Steven Gerrard broke his fifth metatarsal in 2004, again was predicted to return to football 6 to 8 weeks later, but eventually returned after 10 weeks. David Beckham broke his second metatarsal in 2002, was predicted to return 6 weeks later, and stepped back on the pitch after 7. David Nugent broke his fifth metatarsal in 2006, and returned 6 weeks later. He claims that his speedy recovery all came down to drinking lots of milk!

Dr Mark S. Myerson, M.D. a renowned expert in foot and ankle reconstruction at the Mercy Medical centre in Baltimore, Maryland, United States thinks that one the reasons for these fractures in Football players is the fact that many football players are bowed legged and have a chronically unstable or loose ankles. This puts an abnormal amount of strain on especially the fifth metatarsal, increasing the chance of a stress fracture.

Other suggestions explaining why we tend to see more metatarsal fractures these days than we have in the past included: an increase in the number of games played at the top level, an increase in training intensity, or even the training that a lot of teams do on artificial surfaces, which has a higher impact on the body.

Additionally, the pitches seem to be a bit harder these days than what they used to be due to their drainage. Grass pitches are often sand-based to improve drainage. The watering of these pitches increases their speed, but does not improve their hardness.

Players themselves are fitter, faster and stronger than they used to be. Again, this increases the forces that feet have to deal with.
Finally, some specialists argue that todays boots are lighter and less supportive and protective than they were in the past.