Metatarsal injury is the most highlighted in football
The football world first heard of metatarsal fractures when headliners David Beckham and Wayne Rooney got injured. Some say they have always been about but limited knowledge meant they got missed. A ‘sore foot’ can be more serious than you think.
The metatarsals are in the foot, similar to how fingers make-up the hand; there are five of them. They flex and turn when playing football offering support to move. Sprinting, turning and balancing all need the metatarsals to work hard. As the game gets faster and pitches firmer, footballers take these fragile bones to near breaking point.
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Footballers usually damage their metatarsals in one of two ways. The less common way is an acute trauma fracture (break or crack) usually to the second or third metatarsal. Happening after kicking the bottom (sole/studs) of an opponents boot or a stamp - there is little to protect them.
Non-contact injuries more often than not involve the fifth metatarsal. Affecting the underside of the bone as it forcibly twists and bends, this metatarsal is on the outside of the foot.
As players jump, land or change direction at speed, it goes through a range of flexing movements.
There are many opinions on how footballers suffer stress fractures to the metatarsal. These include the type of boots they wear; some say modern boots are too bendy. It's said this can put more pressure on the fifth metatarsal. This pressure causes more twisting forces [ known as torsion ] across the foot.
Some older style boots had studs positioned in a way that increased forces (direct pressure) to the base (underside) of the fifth metatarsal creating more pain.
To help that, football boots and other football equipment have developed with input from sports scientists and biomechanics experts. Cushioning, support and other protective technology are now added to the latest football boots.
The top brands don't just want flash boots that injure their stars do they now!?
Harder playing surfaces that are around today have also been held up as a possible reason; this type of injury happens more when playing on concrete, Astroturf and even some firm natural grass pitches.
ASTRO PITCH IMAGE HERE
Overuse is another cause of stress fractures. Constant pounding against hard surfaces or continued pressure being put through the bone causes pain in the foot. Over time, a stress fracture can develop into a 'full' fracture.
When players do injure the metatarsal, they feel increased pain in the foot, swelling and find it difficult to stand on it. An x-ray will show the damage most of the time.
Sometimes though, a normal x-ray will not reveal the total damage to an injured metatarsal, so a surgeon may use a special machine called a bone scanner or an MRI scan. These machines can show early problems and more detail that x-rays can miss.
SNAP : The 5th metatarsal is the most commonly injured in footballers.
Stress fractures to the metatarsal are tricky to treat. They need rest, which players hate doing.
The start of a player's treatment aims to stop the activity that is causing the pain. A special walking boot or a cast can be used to immobilise the foot. The player will remain in the boot until tests show that the fracture is healing and the surgeon decides to proceed. In more serious cases, the player may need an operation to fix the metatarsal fracture.
PROTECT : Recovering from a metatarsal fracture means totally protecting the injury from any pressure.
Once the fracture has healed, and the pain is gone, a rehabilitation programme with the physio can start. It is too easy for a player to re-injure themselves because they feel better than when the injury first happened but are not yet fully recovered. At this time, the player has to have patience and needs to trust the team's medical staff (surgeon, physio and sports scientists).
Grassroots or amateur players, who won't have access to specialist medical teams straightaway, sometimes unwittingly try and play through pain. With a metatarsal problem, this can cause damage without knowing.
GRASS ROOTS PIC HERE
Immediately following a metatarsal fracture ice can be effective to help with pain. But, medication prescribed by the doctor is usually necessary for serious fractures. Ankle and foot boots using cryotherapy technology work well. They give continuous ice cold water and compression to reduce pain and swelling.
Treatment of metatarsal fractures can vary. Depending on the type and location of the problem will dictate the process. Fractures after a direct blow with a clean break give the option of using a removable plastic cast. The rehabilitation advantages of these casts are they restrict movement and offer protection. During the 6-8 week non-weight bearing period they can be removed for physio sessions.
Stress fractures of the base of the fifth metatarsal don't heal so well.
Pro footballers today are worth millions to a club, time off the pitch costs points and money. Treatments had to be developed to try to speed up the recovery process.
AND BREATHE : Hyperbaric chambers make the player breathe pure oxygen to speed up healing.
These include putting players in oxygen chambers, where the players breathe pure air, which helps to produce healing cells. Also, bone stimulation is used, where ultrasound waves are used to help the body make bone cells to allow the fracture to heal quicker.
Orthopaedic surgeons may operate to fix it. A small screw is placed down the middle of the fractured bone. Players are usually out for around 8 weeks.
The location and nature of metatarsal injuries mean that they can easily happen again or it can take a long time for the player to feel 100%. However - if treated correctly - they will heal.