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What are metatarsal injuries?
Wayne Rooney's metatarsal injury

The dreaded metatarsal curse has struck some of the Premiership's top footballers in recent years.

Manchester United's Wayne Rooney fractured the base of his fourth metatarsal before his miraculous recovery for the 2006 World Cup.

So what exactly are metatarsals, and how long do they take to heal?

WHAT?

Metatarsals are the five long bones in the forefoot which connect the ankle bones to those of the toes.

The first is linked to the big toe and the fifth, on the outer foot, links to the little toe.

The five metatarsals act as a unit to help share the load of the body, and they move position to cope with uneven ground.

Injuries usually occur as a result of a direct blow onto the foot, a twisting injury or over-use.

WHO?

Rooney has broken his metatarsal two times but there are many players who have suffered.

Others include Steven Gerrard, David Beckham, Gary Neville, Roy Keane, Ashley Cole, Ledley King, David Nugent and Michael Owen.

But damage and recovery time depends on the extent of damage and which of the five metatarsals is affected.

HOW?

The middle metatarsals - which are the longest and narrowest - are usually injured as a result of wear and tear (stress fractures).

Manchester United's Wayne Rooney is in agony after breaking his right foot against Chelsea
Will Rooney be fit for the World Cup?
In other words, it is caused by an ongoing process - and not one single occurrence. This is common with athletes, ballet dancers and soldiers.

Impact (eg: someone stamping on your foot) and twisting can also result in fractures.

The first, second and fifth metatarsals are the most commonly injured in sport.

The first links to the big toe and is shorter and wider than the others. It is estimated this bears up to one third of the body weight.

SYMPTOMS

Pain in the bone during exercise, bruising, swelling and tenderness in the foot when weight-bearing.

TREATMENT

Rest. The immediate response is a big "no" to all exercise and sport for 4-8 weeks.

The patient may be asked to wear walking boots or stiff-soled shoes to protect the injury while it heals.

If the cause is over-use, then treatment can vary hugely. Training habits, equipment used and athletic technique should all be investigated.

With a bone fracture, the bone can often have a pin or screw inserted to speed up the recovery.

RECOVERY

It all depends on the damage and which metatarsal bone is involved. It is impossible to put a timescale on recovery from a stress injury.

RECOVERY TIMES
Michael Owen (2006): Fifth metatarsal - predicted 6-8 weeks returned 17 weeks later
Wayne Rooney (2004): Fifth metatarsal - predicted 8 weeks returned 14 weeks later
David Beckham (2002): Second metatarsal - predicted 6 weeks returned 7 weeks later
Gary Neville (2002): Fifth metatarsal - predicted 6-8 weeks returned 21 weeks later
Ashley Cole (2005): Fifth metatarsal - predicted 6-8 weeks returned 12 weeks later
Scott Parker (2004): Second metatarsal - predicted 8 weeks returned 34 weeks later
Danny Murphy (2002): Second metatarsal - predicted 6 weeks returned 21 weeks later
Steven Gerrard (2004): Fifth metatarsal - predicted 6-8 weeks returned 10 weeks later

After initial rest, the training techniques or body mechanics may need minor tweaking or a major haul to avoid a repeat injury.

With an impact fracture, after the plaster and protective boot is not needed (usually after 4-6 weeks), it will be a case of exercise and increasing weight-bearing activities.

Ice packs, strapping and even the use of oxygen tents can be used to assist recovery.

Full return to action can be anything from another four weeks and upwards - depending on the extent of initial damage. Young bones heal quicker.

One factor that also helps is if the broken bone is one of the three inner metatarsals. As was the case with Rooney.

This means that the fourth metatarsal is aided by the 'splint effect' of the bones on either side.

Preston's David Nugent broke his fifth metatarsal in March 2006 and returned to action after being sidelined for just six weeks.

His remedy? Drink plenty of milk.

WHY SO MANY INJURIES?

The breaking of a metatarsal seems to be increasingly common among England's top stars.

There are many theories being put forward to explain why so many players have fallen foul over the last few years.

Some believe it is the number of games played at the top level, some say training is more intensive, and others argue that training on artifical surfaces has a higher impact the body.

Evolving designs of boots have also come into question.

Many boots are now much lighter and more flexible, with a variety of new studs and blades available.

Some suggest that players' feet are less protected and supported than a few years ago.



SEE ALSO
Metatarsals - a football fad?
04 May 06 |  Health & Fitness


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