Best foot forward

If you complained of a broken metatarsal as recently as 2001, chances are you would have received nothing more than a blank stare by way of response.

Then, on April 10 2002, Argentine Aldo Duscher clattered into one David Beckham in a Champions League match between Deportivo La Coruna and Manchester United, breaking a bone in the England player's left foot, and a new word was added to the football lexicon.

As with many things, where Beckham treads, or hobbles in this case, others follow. Wayne Rooney, Gary Neville, Steven Gerrard and, most recently, Michael Owen have all fallen foul of a fracture to one of the five elongated bones in each of their famous feet.

But though it was the England captain who propelled the bones in question into the public consciousness, he was not the first to have problems in that department.

'A stress fracture of the second metatarsal, originally called a march fracture, was first recorded in 1850,' explains Professor Nicola Maffulli, one of the world's most eminent consultant orthopaedic and sports injury surgeons, speaking in his Harley Street offices. 'It was described in the Prussian army when recruits were given heavy boots and told to march 70 kilometres.'

And you don't have to be an international sports start to suffer. 'Only last week I treated a 41-year-old non-athletic lady for exactly the same problem that Wayne Rooney experienced,' Professor Maffulli continues. 'In general practise it happens every day.'

Despite such an affliction being little more than an occupational hazard (and steering well clear of Rooney's connection with middle-aged women) it will continue to occupy the minds of all England fans as long as one of their key players, Owen, is sidelined with the World Cup now less than 100 days away. So Professor Maffulli's words should at least ease some worries.

'The likelihood is that Michael Owen will be back in plenty of time for the World Cup,' he suggests. 'There is always a degree of variability from person to person, no two cases are the same. But he has been operated on by a very good guy so the likelihood is that the operation was successful, so he will be back quickly all being well.'

And he should know. In a 14-year career, in which he has achieved more honours in his field than Ryan Giggs has medals, Professor Maffulli has saved the careers of countless top level athletes, pioneered revolutionary procedures and techniques in foot and ankle surgery, written six books on the subject and contributed to Nike's first ever orthopaedic training shoe.

David Batty, Jaap Stam, Quinton Fortune, Christian Zanetti and George McCartney have all been patients of his, whilst Thierry Henry recently sought his expert opinion. Ignoring any temptation to operate on the great Frenchman, he concluded surgery was unnecessary; a view Real Madrid will no doubt ruefully concur with.

As the pace of the game continues to accelerate and players in every position are increasingly asked to be athletes first and footballers second, the temptation is to assume that injuries of this kind are somehow inevitable.

As something of a last port of call for the injured -'they come to me when things have gone very badly wrong' - the cases Professor Maffulli sees are far from representative of the norm, yet he has seen a trend towards what he describes as 'overuse' problems.

'In general I've been seeing more soft tissue injuries in terms of tendon problems, especially in the ankle,' he says. 'Now all the major clubs have implemented good programmes so that anterior cruciate injuries, for example, don't seem to be such a problem as they were ten years ago.'

'Those injuries were caused because there is a small trauma that is repeated until it overcomes natural resistance and ability to recover from that small injury itself can be prevented: better training, proper warm up and warm down routines and proper coaching.

'But the acute injuries are difficult to prevent. They just happen because they happen.'

One such injury was the sickening broken leg and dislocated ankle suffered by Alan Smith during Manchester United's FA Cup defeat at Anfield.

'It didn't happen because of bad training; it's one of those things - he could have done it at home slipping on some steps,' says Professor Maffulli.

Despite the gruesome nature of Smith's injury, Maffulli, though judging the situation from afar, has good news for the United forward-turned-midfield enforcer.

'Surgical techniques have advanced,' he reflects. 'Provided the bones have been fixed in a stable fashion, now we go for much earlier and much more aggressive rehabilitation. Ten-fifteen years ago he would have been told 'we'll have to see how it goes'; now we can more reliably state he has a good chance of getting back.

'In the first two weeks or so you need to get the skin healed, the wound that has been produced by surgery healed. After that it is gentle mobilisation to start with, gradually returning to normal over the following months.

'Top level athletes are extremely well conditioned, but if they don't keep training their muscles waste away. Put it this way: they probably need twice as long to recover to the level they were at. You are talking about people who are in the top 5%: the elite of the elite. So they need to be absolutely perfect before they can return to the pitch.'

So, freak and horrific accidents such as Smith's aside, is there an argument to be made that top level players in the modern game are being asked to play too many games?

'Unfortunately we only ever understand what is enough by discovering what is too much,' says Professor Maffulli. 'So it is difficult to give figures on that. If any sport is practised to the hilt it gives problems.'

And any advice for us mere mortals, who content ourselves with a weekly kickabout on pitches that would make the Stamford Bridge groundstaff blush?

'A game should be the conclusion, the peak of the week for anyone at any level,' Proffessor Maffulli warns. 'If you just go on the pitch and play you are more likely to get injured than if you do other exercise or training before and after.'

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