William Saliba’s “fissure of the 5th metatarsal”: Explaining the injury and long-term impact

Arsenal loanee and current St. Etienne center-back William Saliba suffered a “fissure of his 5th metatarsal” during the team’s 1-0 victory over Monaco on 11/3. In this article, I’ll explain the injury and what it means for the young developing starlet moving forward.

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The injury

A fissure of the 5th metatarsal likely means Saliba has a small crack in the long bone on the lateral (outside) part of the foot that connects the midfoot to the base of the 5th toe (aka the pinky toe).

This injury most commonly occurs at the base of the 5th metatarsal which is divided into three zones – zone I, II, and III. The zone of the injury is key for determining severity, the return to play process and timeline, and risks moving forward.

What zone does Saliba have?

We haven’t been given any further anatomy details but here’s what we do know:

#1 Acute impact injury

According to the club statement, Saliba was the “victim of a blow” during the Monaco game. In other words, this was an acute trauma injury.

#2 No surgery

There’s been no indication that Saliba underwent a surgical procedure and if one was required, it nearly certainly would’ve taken place already.

#3 Reported return timeline

It’s been reported that Saliba’s return to play (RTP) timeline is around four weeks

Connecting the dots…

Based on this info, Saliba’s fissure of the fifth metatarsal lines up most with what’s known as a “non-displaced zone 1 fracture” aka a “pseudo Jones fracture”.

Return to play (RTP)

The return to play process for a nondisplaced zone 1 fracture begins with modified weight-bearing to take stress off the bone, commonly in an aircast or rigid shoe. Saliba would then transition to a normal shoe and barefoot, as tolerated.

Simultaneously, Saliba will be working on foot and ankle mobility and strengthening, more weight-bearing, and eventually progressing to higher intensity activities.

Will this affect Saliba’s future?

Excellent outcomes

The great news is that outcomes are excellent with this injury. The rates of nonunion – aka the crack not healing – are very low, between .5% and 1%,  with no evidence showing increased risk of reinjury or negative impact on performance.

My one concern

If there is one concern, it’s not the injury itself but rather the multiple chunks of time Saliba has missed this season. If he is back in the reported four weeks, he’ll then have missed ten weeks total this season when you add in the six weeks he missed early on due to adductor injury and surgery.

These long breaks and activity fluctuations can impact fitness levels while increasing soft tissue (bones, muscles, tendons, ligaments, etc) injury risk while decreasing on-pitch time for a still developing player. 

However, gradual methodical physio and strength and conditioning can mitigate many of these injury risks and if his return after the adductor surgery is any indication, he won’t have missed much of a development step when he gets back either.

That being said, Saliba may have some discomfort and soreness along that lateral part of the foot for up to six months but that’s part and parcel with this injury. 

All in all

Overall, you never want to see young players get hurt – let alone multiple knocks in one season – but if my inferences are correct, it’s a relatively mild injury and I don’t expect it to limit Saliba’s trajectory or performance levels in the medium or long-term.

That’s a wrap for this piece. Thanks for watching. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the blog below and the YouTube channel for the latest updates. 3CB out. 

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