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Metatarsals - a football fad?
Wayne Rooney breaks his foot against Chelsea
The agony began for England's Wayne Rooney against Chelsea

Wayne Rooney is on crutches and the word metatarsal is being uttered yet again across the country ahead of a World Cup.

It was David Beckham in 2002 and now Man United's star striker is the subject of hourly medical updates after breaking bones in his foot.

So what is all the fuss about, why does it seem to be happening more and is it an injury than can be prevented?

BBC Sport asked Professor of Sports Science Tom Reilly, Sport Specialist Richard Higgins and Reading physio Jon Fearn.

IS THIS A NEW PHENOMENON?

Fearn: It has always been around and used to be called a broken foot. After all the Beckham analysis in 2002 the metatarsal word came up and has been used ever since.

I've been at Reading for five years and we've never had one, but I have never known so many England players to suffer.

Higgins: It's a phenomenon of modern sport and has been increasing over the last 15 years.

Many of these metatarsal fractures are because of stress or over-use. There have always been stress fractures in sport, but training and the intensity of training has increased hugely.

Reilly: It has always been traditionally recognised. There has always been a combination of breaks due to over-use and impact fractures.

There are not necessarily more or less metatarsal injuries now but we all certainly know more about it.

Over the last four years because of high profile injuries, there is better knowledge in the game and it is being commented on more in the public domain.

IS IT A COMMON FOOTBALL INJURY?

Reilly: Most football injuries are in the lower limbs, although the shoulder is a common one, especially for goalkeepers.

So the knee, ankle and feet bones are often on the receiving end due to contact and changing body posture when trying to avoid other players.

WHY IS IT HAPPENING MORE?

Higgins: Pitches are harder these days and players at the top are fitter, faster and stronger.

The stresses players' feet endure are hugely different to 20-25 years ago.

David Beckham suffers in 2002
Metatarsal woe for Beckham in 2002
Grass pitches are often sand-based to improve drainage. These will be watered to increase speed, and not necessarily to make them softer.

It can be like running on concrete. Today's boots are probably less supportive and lighter, which will add to the stresses on the bones.

Fearn: The pitches are a major factor. Metatarsals often break due to increased stress levels and these stresses change with differing playing surfaces.

Premiership stars play on gorgeous surfaces day in, day out and any slight change in conditions will mean their feet may not be conditioned for that surface. Playing on a variety of surfaces creates different stresses and this is beneficial.

Bones respond to load and if you don't provide the high load the bones can become weaker and vulnerable.

However, if the workload is intense without rest or players just work on soft surfaces they again become susceptible to fracture.

Boots have become very cosmetic. Blades, for example, have been banned by some clubs and I advise against them. They make the lower limbs very vulnerable.

They are like crampons in mountaineering. We recommend a more conical stud so if a player spins, they spin on a cylindrical point rather than having something that just grips.

The upper part of a boot used to be a lot stronger for protection. Now they are made of flimsy plastic that feels like paper, but many players seem to want that lightweight feel of the boot.

CAN THIS INJURY BE PREVENTED?

Higgins: All these metatarsal breaks are stress fractures and you only really see it with players who train intensively at the highest level.

The benefit of oxygen tents has never been proven, but if there is a chance it may work it has got to be worth trying
Reading physio Jon Fearn

Improving your bone density will hugely help a player avoid this kind of fracture and bone density responds to training.

When beginning training, I always advise a gradual start over the first 6-12 months and then slowly build this up.

Fearn: It sounds simple, but jumping up and down on a concrete surface will really help.

Research many years ago into osteoporosis for old people involved getting sheep to jump up and down! Over time their bones strengthened tremendously!

And when buying boots, don't always look at fashion. You need to combine comfort with what is right for the playing surface.

Reilly: Players are totally at the mercy of what happens around them and many injuries are unavoidable.

But many injuries are associated with being anxious. So when tackling, for example, it is important to be committed.

Jumping provides stimulus for bone growth and there is a need to build your calcium intake - drinking milk is not an old wives' tale.

WHAT HELPS RECOVERY?

Fearn: Rooney will need to be fit, be able to train and feel match sharp to be ready for the World Cup. It is a massive risk if any player is rushed back.

Firstly, you need to maximise the healing. An Exogen device using low intensity ultrasound sends a pulse through the bone and stimulates growth.

Wayne Rooney
Rooney picked up a similar injury at the 2004 Euro Champs
The benefit of oxygen tents has never been proven, but if there is a chance any facility like this may work then it has got to be worth trying.

Aqua belts in the swimming pool enable players to run without bearing weight on their lower limbs so this is beneficial to improving aerobic fitness.

Higgins: Using ultra sound waves can really speed up healing. It is used three times a day, 25 minutes each time.

With a metatarsal break the legs are not put in plaster and you will see players in removable air cast walkers.

This allows full treatment to the foot when needed. The load on the foot is then built up as the pain resides.

Tom Reilly is a Professor of Sports Science at Liverpool's John Moores University.
Jon Fearn is a physiotherpist at Reading Football Club.
Richard Higgins is a specialist in sport and muscular medicine.



SEE ALSO
What are metatarsal injuries?
29 Apr 06 |  Health & Fitness
Pitches blamed for Rooney injury
02 May 06 |  Internationals
Life without Rooney
03 May 06 |  England


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