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Paris Saint-Germain superstar Neymar da Silva Santos Jr., who suffered a “sprain of the right ankle and fissure of the fifth metatarsal” last week, will miss Tuesday’s big match against Real Madrid and likely many more.
On Sunday, Neymar underwent a successful repair of the injury, which occurred on Feb. 25 in a match against Marseille. But just what is a “fractured fifth metatarsal”? How was Neymar’s injury repaired? What is his estimated recovery time? And how will this affect PSG’s chances at the Champions League title?
The metatarsals are the long bones in the foot that connect to the toes, and they are the most important weight-bearing structures of the forefoot. The fifth MT is the one on the outside of the foot that connects the ankle/hindfoot to the pinky toe. It is particularly important because more motion occurs at the fifth MT than at any of the other metatarsals, and several muscles attach to it that play critical roles during the gait cycle. A fracture to this area will affect the biomechanics of the foot, making walking painful. And anything that makes routine walking difficult is going to make returning to the field even more of a challenge.
Fifth-metatarsal fractures are quite common in sports like soccer, basketball and gymnastics, as well as jogging, ballet and high-impact aerobic activities. In fact, these fractures are often referred to as Dancer’s Fractures (or Jones Fractures). Other well-known soccer players who suffered this type of injury include David Beckham, Steven Gerrard, John Terry and Gabriel Jesus.
Most fifth-MT fractures may be treated non-operatively, depending on the location of the injury and the fracture’s severity. Non-operative treatments include painkillers, ice, rest and a few months of immobilization. A critical factor when determining the appropriate treatment for fifth-MT fractures is delineating the exact location of the fracture in the bone because the blood supply to certain areas of the bone is a bit more tenuous. Without good blood supply, the body has a difficult time healing broken bones. Athletes may also choose surgery over conservative treatment to avoid the prolonged immobilization required for successful non-operative treatment.
In Neymar’s operation, completed by Rodrigo Lasmar, a screw was placed across the fracture site in the fifth MT of the right foot. Lasmar reported that Neymar’s recovery time would take up to three months, ruling him out for Tuesday’s Champions League round-of-16 second leg with Real Madrid. The current plan is to have Neymar reassessed in six weeks to establish a possible date for returning to training.
It is important to caution that while healing rates for these fractures approach 97%, there is the risk, especially in athletes who return to the field too soon, that a non-union develops. This situation can be devastating to an athlete, requiring a second, more invasive surgery and a prolonged postoperative rehabilitation course and resulting in worse expected outcomes. With this in mind, it would behoove PSG not to rush Neymar back — that could affect his ability to represent Brazil in the World Cup in June!