Why I'm Concerned Neymar Might Be Out Of the FIFA World Cup
You may have heard about the Neymar, even if you are not a soccer (football) fan - he's the Brazilian striker that cost Paris Saint-Germain US$263 million to buy from Barcelona, then gets paid over US$1 million/week. Good work if you can get it!
...He's also quite a useful player - check out the video below to see a few of his best goals. He was only around 17 when he scored the goal at number 1 on the list as well!
So why am I making a blog post about him? On Sunday, Neymar rolled his ankle in a Ligue 1 match in France. All the media attention has been focussed on how he is going to miss PSG's match against Real Madrid this week. Sprained ankles generally take a few weeks to recover, so whilst I thought that he woud probably not play against Real Madrid, I didn't think anything more of it.
Here is a video of the incident, if you are curious:
When A Sprain Becomes An Avulsion Fracture
This morning I woke up to an article on the BBC where PSG stated:
"Follow-up exams performed today confirm a sprain in the right ankle, but also the associated presence of a crack of his fifth metatarsal"
A lot of newspapers are suggesting a 10-week layoff for Neymar, since this is what the approximate time-frame is for other metatarsal injuries according to them.
This isn't like the broken bone David Beckham got in 2002, which caused him to play for England in the World Cup 50% fit. That was caused by blunt trauma to the foot by a bad tackle. This is worse.
What Is An Avulsion Fracture?
Essentially, an avulsion fracture when bone gets broken off as a ligament or tendon is pulled from it. In the case of Neymar, he is likely to have an avulsion fracture of the head of the fifth metatarsal:
The circle in the diagram above shows the insertion of fibularis brevis, a muscle that attaches into the head of the fifth metatarsal, in the foot. When you roll your ankle in, the ligaments get stretched and torn, but so do the muscles. When Neymar rolled his ankle, his fibularis brevis tendon would have been pulled so much that it actually pulled off the head of the fifth metatarsal along with with the tendon.
Neymar's X-Rays would look something like this:
What Is The Treatment?
Unfortunately, this is not an injury where there is much that can be done from a physio's perspective. In the past when I have seen these injuries, you put the foot in a moon boot for at least 6 weeks. You get another X-Ray. If it has begun to heal, great. If not, you put it in the moon boot for a while longer. Check the X-Ray again. If it is not healing, you might fix it up surgically.
The recovery for this injury can be a long process.
Another high profile victim of this injury is Ben Simmons, the Australian rookie currently taking the league by storm. At the end of 2016 however, he fractured his 5th metatarsal just before the start of the NBA season.
He was out for a full year.
The article below discusses these concerns at the time for Simmons:
Simmons made a full recovery as you may know, and is expected to win Rookie Of The Year in his first season playing in the NBA.
Interestingly, in doing a bit of research for the background behind David Beckham's foot injury, an article in The Guardian interviewed a surgeon:
Professor Angus Wallace, professor of orthopaedic and accident surgery at the University of Nottingham said: "Metatarsal bone fractures are common, they usually heal within six weeks."
"However if it [had been] a fracture of the fifth or outer metatarsal, delayed healing can be a problem,"
Neymar unfortunately, does not have time on his side, with the FIFA World Cup coming up in around 3 months. I will be hoping he is back fit and healthy, although it is quite possible that he will be out for a significant period of time. I hope I'm wrong.