Metatarsal stress fracture, the case of the Gasol brothers

The metatarsal stress fracture is a pathology that affects the foot and is slow to heal. This injury is preventable, but it is often underestimated until it has serious consequences. The brothers Pau and Marc Gasol, elite basketball players, both suffer complex foot injuries due to this fracture known as “feet of clay”. The two athletes have seen their professional careers affected because they were not treated in time.

The Gasol brothers’ feet of clay

Pau Gasol, at the age of 26, was playing in the semifinals of the 2006 World Cup when he injured his foot in a normal under the basket. The specialty in sports traumatology recognizes this injury as a stress fracture, which caused Gasol to miss the final of that World Cup.

His brother Marc already had previous pain in the area as a result of small cracks that warned of the possibility of the fracture, but the physiotherapists of his team ignored it. He finally broke the bone, with an injury that requires a recovery of between three and six months.

There are three areas of particular weakness in the foot with the highest risk of injury: the neck of the 2nd and 3rd metatarsal and the metaphyseal area of the 5th metatarsal of the foot. The elite basketball player is a repeat pattern in this type of stress fracture, as he presents these three factors:

• Very high weight: each foot of the Gasol brothers has to support approximately about 60 kg of weight.
• Repeated overload: This is seen in basketball players in very demanding competitions such as the NBA, who play 2 or 3 games a week, or in marathon and ultramarathon runners.
• Alteration of the shape of the foot with the passage of time: A change in foot support occurs as a result of increased pronation, due to insufficient tendons and ligaments of the medial and plantar part of the foot.

12 tips to avoid metatarsal stress fracture

Metatarsal injury or muddy feet can be prevented. The following highlights 12 preventive measures that can be followed to avoid it:

1. Wear customized, dynamic, resilient and memory insoles, which should be renewed every year or every 2 years.
2. Annual gait studies. Some alterations in the gait pattern change from year to year and require periodic revisions.
3. Perform tests such as MRI or grammagraphy to detect possible risks.
4. Avoid being overweight. With less weight to bear on the feet, these injuries are more difficult.
5. Strengthening exercises for ankles and feet.
6. Avoid resting on the hardest surfaces.
7. Use shock-absorbing shoes and avoid hard cleats when playing soccer. In fact, the Argentine soccer player Lionel Messi also suffered this injury.
8. Avoid fatigue in the foot muscles by practicing routine and prolonged exercises. It is better to opt for varied and intermittent exercises.
9. Maintain good podiatric hygiene, avoiding blisters, chafing or other painful injuries that make you change the type of support.
10. When exercising, gradually increase the intensity, distances and training times. Never exceed 10% per week, especially during the recovery period for all types of fractures.
11. Measure vitamin D levels in the blood. Especially in indoor sports such as basketball, and in countries with cold climates. A low vitamin D level increases the risk of stress fractures.
12. Avoiding all-vegetarian or low-protein diets, as well as diets low in calcium.

Treatment for metatarsal stress fracture injuries.

Once the injury has been acquired, it is important to maintain muscle bulk to facilitate subsequent return. This can be achieved with non-load bearing sports such as swimming, gym or cycling. Surgery shortens the recovery time.

The stress fracture initially requires rest and a very progressive subsequent return: approximately 10% per week and a period of stabilization achieved at 50%. In addition, it is necessary to prevent on the other foot, since up to 25% of these injuries can be bilateral.

In short, Pau and Marc’s feet need more prevention, more personalized treatments, weight control, diet control, more resistant plantar supports, tendon and muscle toning inside the foot and stabilizing the ankle, avoiding as much as possible additional overload from training and games, measuring vitamin D levels and progressive reincorporation. These stress fractures are in the case of many athletes the main risk for their professional careers, which by taking care of all these details can surely be much longer and more successful.