Before I talk about van Persie's injury, here is a quick review of the anatomy of the foot. The view to the left is from above, as if you are looking down at your foot.The bones are labelled as follows: 1st metatarsal (1), 2nd metatarsal (2), 3rd metatarsal (3), 4th metatarsal (4), 5th metatarsal, medial cuneiform (M), intermediate cuneiform (I), lateral cuneiform (L), cuboid (Cu), navicular (N), talus (T) and calcaneus (C).
The only blemish on a wonderful victory on Sunday was the news that van persie fractured his fifth metatarsal. Initially the reports were that he injured it whist celebrating his goal but the footage of him scoring showed no mechanisms of injury whilst he celebrated. Instead it seems as though the outside of his right foot twisted in the turf as he stretched to meet the ball. The arrow on the view to the left shows the probable site of injury, which is a comon site of injury in footballers.RECOVERY TIMES (Source: BBC Sport)
Michael Owen (2006) 5th metatarsal predicted 6-8 weeks returned in 17 weeks
Ashley Cole (2005) 5th metatarsal predicted 6-8 weeks returned in 12 weeks
Scott Parker (2004) 2nd metatarsal predicted 8 weeks returned in 34 weeks
Steven Gerrard (2004) 5th metatarsal predicted 6 weeks returned in 10 weeks
Wayne Rooney (2004) 5th metatarsal predicted 8 weeks returned in 14 weeks
David Beckham (2002) 2nd metatarsal predicted 6 weeks returned in 7 weeks
Gary Neville (2002) 5th metatarsal predicted 6-8 weeks returned in 21 weeks
Danny Murphy (2002) 2nd metatarsal predicted 6 weeks returned in 21 weeks
What the data above show is that clubs predict between 6-8 weeks for the rehabilitation of matatarsal fractures, however these injuries are notoriously unpredictable. Some require surgical pinning, whilst others do not and some individuals have a poor blood supply to certain areas of the fifth metatarsal, which would delay healing. The average rehabilitation time of the eight players listed above is 17 weeks, which is a long time, but it is made to look worse by the 34 week recovery of Scott Parker. If he is taken out of the calculation, the average time is 14 weeks. What must be acknowledged is that Arsenal have an excellent medical team and that van Persie will be receiving the best quality care, but either way, he looks to be on the sideline for a long time.
The injury van Perise sustained is called a Jones fracture and is named after the first physician to write about the injury. Sir Robert Jones wrote an article on fractures of bones within the foot in 1902 and included a fifth metatarsal fracture he himself had sustained. He referred to it as a Jones fracture and it has been named as such ever since.
The next step for the medical team at Arsenal is to decide if it needs to be pinned. If it does then this is what will take place.
The first image shows the foot prepped for surgery. The lines signify the location of the bone to be repaired and a tiny incision is made to enable the minimally invasive surgery to take place.
The second image shows a guide pin being placed in the centre of the bone. This pin will allow the surgeon to place the screw in the correct location within the bone. The fracture is visible just above the base of the fifth metatarsal.
The third image shows a small drill being inserted into the fifth metatarsal. It is guided by the pin and the titanium alloy screw is slowly drilled into the bone.
The fourth image shows the space between the two fragments of bone has been reduced and the screw is perfectly aligned within the bone.
The incision is only 3mm long, the surgery takes approximately 15 minutes, no cast is required and the patient can walk immdeiately. The only concern for van Persie would be if he failed to heal efficiently. There is a chance that he won't require surgery and if that is the case he would undergo a conservative treatment, where his bone would be allowed to heal itself naturally.
In the meantime van Persie will be maintaining his cardiovascualr fitness in the gym.
