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Foot loose; fancy free? The English squad would strongly disagree.

In World Cup 2002, the England squad became more notorious for its injuries than its on field exploits. One by one David Beckham, Gary Neville, and Danny Murphy fell prey to the broken foot. At fault were these five little bones called the metatarsals. The trio of injured midfielders became emblematic of England's botched efforts in the last World Cup. Although Beckham recovered in time for the World Cup matches, he was out for more than two months rehabing and it showed as he struggled on the field.

What are the metatarsals?

The metatarsals are the five bones in the foot structurally analogous to the metacarpals in the hand. The metatarsals as a unit in the forefoot provide a broad plantar (on the sole) surface for load sharing. They are mobile in the sagittal plane (up and down) and individually the metatarsal heads can alter position to cope with uneven ground.
Stress fractures of the metatarsals are common in footballers and occur mostly in the second and third metatarsal necks and at the proximal portion of the shaft of the fifth metatarsal. Pain, deformity, crepitus, swelling, bruising and increased pain on weight bearing are the cardinal signs and symptoms.

Stress fractures are thought to be caused by overloading of the metatarsals through repeated weight bearing as seen in football. They lead to microfractures of the metatarsals. Another theory is that excessive muscular fatigue of the foot musculature lead the metatarsals to being vulnerable to fractures, especially the second metatarsal. The dreaded carpal tunnel syndrome that has led many to wring their hands in distress, is also attributed to the repetitive motion of keyboarding. So secretaries and English Premier league players have something in common, although the damage done through loss of business due to CTS is far greater than a landed football player missing out on squad duty through injury. But somethings are more sacosanct than the economy and rightly so.

So far the dreaded metatarsal virus this season has claimed Michael Owen, Ashley Cole, Steven Gerrard, Wayne Rooney, and most recently Ledley King.

We, at Soccerblog did a check on the football injuries of all the Premiership League teams. Of the 70 currently injured players, five had metatarsal fractures. Significantly, Michael Owen and Ledley King, who are England squad sureshots are sidelined by these injuries.

12 had knee injuries (mostly ACL sprains or tears), 11 ankle sprains, 7 hamstrings, 6 groins, 4 ankle fractures, and 15 assorted injuries including Sol Campbell's broken nose. There was also a sports hernia and a case of glandular fever. So metatarsal fractures accounted for about 7% of the total injuries. In a study examining military recruits, about 7.6% of lower extremity (leg) injuries were metatarsal in nature (Milgrom, et al., 1985).

The reason attributed to metatarsal fractures as compared to the other injuries that are more traumatic in nature, is the long Premiership season. It is quite remarkable that the more successful clubs had more metatarsal injured players on the roster as they played more matches. David Beckham, Gary Neville, and Danny Murphy all sustained injuries at the latter part of the season lending credence to the theory of cumulative overloading of the metatarsal bones and fatigued foot musculature.

Sven Goran Ericksson and Arsene Wenger have rightly called for a winter break during footie season.

No reports on bruised egos but I am sure there are plenty.

More about metatarsal injuries
Metatarsal injured football players
Anatomy and management of metatarsal injuries

UPDATE: in case you're interested in repetitive stress injury (RSI), here's what the Google doctor says. Maybe the good doctor can give us some tips on avoiding the agony of de feet!