Hi guys. I hope someone can help. Right at the start of December I injured my right foot in football training after a hard tackle in which the foot went over the top of the ball at force, with a player tackling from the other side of the ball.

X-Ray the next day (on a foot giving me real pain and allowing little weight bearing) showed no break, and it was thus assumed to be ligament problems. After resting it for 4 weeks, I returned to training and on striking a ball the pain was excruciating and I knew I had to stop. I should add I had been doing light work before doing this and was getting no pain from jogging and twisting on it.

After this I visited a ‘specialist’ who looked at my foot and suggested (and I quote):

Examination: Normal alignment. No obvious swelling. Normal ski stance, tip-toeing and standing, dorsiflexion, inversion and eversion. Point tenderness over the medial side of the 1st tarso-metatarsal joint. Pain on passive movement of the 1st tarso-metatarsal joint. Remaining tarso-metatarsal joints painfree. Full range of painfree movement of midfoot and hindfoot. Tibialis posterior and tibialis anterior functioning normally.
Impression: I think that it is likely he has injured the capsule of his 1st tarso-metatarsal joint during a forced plantar flexion injury. I have recommended he avoid vigorous activity and pivoting for a total of 3 months.

From this appointment an MRI was arranged which happened two weeks later (8 weeks injured). From this the specialist suggested:

I would like to confirm that the MRI scan has shown some oedema affecting the medial cuneiform in keeping with micro fractures (bone bruising). With this in mind I would recommend you avoid any contact for a total of 3 months from when the injury occurred. Injuries such as this are somewhat unpredictable in terms of length of time… I would be optimistic the foot would have completely settled within 6 months.

I was glad to be finally diagnosed. Anyway, being 8 weeks into the injury at this stage I rested for another 4 weeks to take it to the 3 months recommended and returned to training. My mind was telling me my foot wasn’t ready to strike a ball again, but after slowly building my confidence I was able to slowly build up to being 100% capable of full force. Nevertheless, the foot still gives me pain, especially now I have begun to play in matches again, especially the day after. It is far from excruciating, more niggling, but it makes me wonder whether I should be pushing it this hard and whether I am one strong tackle away from being back to Stage 1 all over.

We only have 4-5 weeks left of the season then I can afford the top of my foot another 6 weeks rest from kicking a ball, which I am sure will do it no harm.

I guess my questions are:

- does this diagnosis sound right?
- can I re-inflict the injury?
- is there anything to aid recovery? (I have been using ultra-sound treatment thus far, twice a week)
- would you expect it to calm down and be pain free given the imminent 6 week rest?

Sorry for all the detail – just thought it might help. Would love to hear any views on this injury as it is my first one ever and it has been very frustrating!!

Regards!

I should add, when I say football I mean soccer!

And I am 24, with excellent general health and few previous injuries. I am a semi-pro - soon to be professional - soccer player.

Howdy and welcome.

I guess if we were to hang a name on this, we'd call it a stress fracture of the medial cuneiform. The good news is that the fracture is in good alignment and is stable. Therefore in time it ought to heal with no residual problems. But the question is time...

The cuneiform is a funny shaped bone that we could describe shaped as a box. The outer surface is hard and the inner surface is soft. Surrounding the cuneiform are many ligaments. Fortunately, those ligaments create an envelop of sorts that splinted the fracture at the time of injury. The ligaments are what prevented dislocation of the bone and displacement of the fracture.

The problem with this fracture is that it will take a long time to heal. And when you're trying to return to play, how can you speed things up a bit?

There are a couple of things that can be done, but you're going to have some big decisions. The first thing is rest. You have to give it a reasonable period of rest. How long? I'd say give it six months. I know that shoots the rest of your season, but it may be worth it in the long run.

What it it doesn't heal? You might need to stimulate the bone a bit through several different kinds of surgical approaches. One way is to place a small bone graft across the fracture site. another is to drill the bone. With this technique, you simply make a Swiss cheese approach to the bone in an attempt to stimulate healing. See what I mean about the decisions?

So what to do? I'd rest it. And then 6 months prior to next season, see if you need to try any of these surgical approaches. If so , that'll give you a reasonable 3-4 months to heal.

Jeff

Thank you for taking the time to reply Jeff! I have been checking three times a day to see what you had to say!! As you have suggested, several people have suggested that 'stress fracture of the medial cuneiform'.

I played another match on Tuesday and despite being slightly anxious it gave me no problems at all, and if anything felt better (looser) for it! The improvement this time round from when I tried to comeback last time is incomparable and now it just niggles.

My question was really whether I was likely to re-injure, which I know is an impossibillity to answer, especially over a forum!

Nevertheless, I guess it is as much personal judgement as much as anything and at the moment it feels OK to expose the injury back to full competitive level for the next 4 weeks - say 10 matches. Then enjoy the 6 week rest of the close season.

I am being naive to expect that if it doesn't worsen between now and the end of the season (may 3rd say), that when training starts again at the end of June, I should expect it too feel 'fully' healed and the niggling gone?

If it hasn't then I am guessing I should pursue further options, like as you suggested, surgery?

My only other question Jeff was regards to helping the injury during the close season... Would ultrasound help/harm?

Once again, thank you for your time...

Well that's good news. I reckon all you can do is give it a go and see what kind of response you get.

Ultrasound? sure, wouldn't hurt.

Jeff