Real Madrid is just settling into a new era, but their midfield rock just cracked again. Xabi Alonso was diagnosed with a fracture in his foot, according to multiple reports, an injury that will keep him out for up to three months. Carlo Ancelotti will now have to adjust both his chosen XI and potentially his transfer plans.
The fracture is in his right foot, on the outside. The fifth metatarsal is heavily stressed during running, especially lateral cuts. Alonso will have a difficult time cutting to his left, which requires planting the injured right foot and putting all the stress onto the healing area. The Real Madrid medical staff will have to make sure that the bone is healed before allowing him to even try this.
Most fractures of this type will happen at the base of the bone, called a Jones fracture. Fractures can also happen in the shaft of the bone, which often requires fixation with either pins or a screw. There is no indication that Alonso will need more surgery at this stage, which is a plus for both his treatment and return.
Other elite players who have suffered this type of injury include Steven Gerrard, who had a similar fracture in 2004. It took him 10 weeks to return. Michael Owen took 17 weeks to return from this type of fracture back in '06, though Owen's medical file is famously thick.
Footballers put more stress on their fifth metatarsals than most running athletes due to the demands of their sport. Some studies have shown that many players have chronically unstable ankles, an adjustment to the continual cutting and regular hits to the ankle on tackles. Dr. Mark Myerson also points out that many players have developed a tendency to bow their legs, a stance that puts additional stress on the outside of the foot.
The 31-year-old Alonso missed much of the summer, including Confederations Cup play in Brazil and the International Champions Cup in America, with a groin injury that required surgery. The surgery to correct a problem known as a sports hernia is standard, and Alonso has shown a normal recovery. He was also out for Sunday's La Liga opener against Real Betis, due to a lack of match fitness.
It is possible that both the recovering groin and his conditioning contributed to the injury. Often players with a leg injury will compensate unconsciously, changing the way they run. That puts new stresses in different locations and can contribute to injuries.
Without Alonso available, Los Blancos are likely to lean heavily on Luka Modric. While Modric has been a rumored transfer target, with many—including The Guardian's Jamie Jackson—pointing him back to England and a Manchester United team that is thin in midfield, it is unlikely that Real Madrid could let him go at this point.
The depth at the position is a bit more problematic. Asier Illarramendi is the truest defending midfielder, with Sami Khedira showing much more of a tendency to push forward. Khedira did show he was working on this during his play this summer, while Illarramendi has struggled to adjust to play at Madrid, according to Spanish newspaper Marca.
If more depth is needed, Ancelotti could be forced to pull Isco or Kaka back, though neither is as strong a defender as needed for Ancelotti's offensive system. Having to bring either to the back could push Real Madrid to make one more strong bid for Gareth Bale, more of a natural wide player.
Real Madrid's medical staff is definitely world-class, though there have been a number of injuries and issues. The team tends to be very conservative with returns, and the timing given on Alonso reflects that. They also usually have enough depth at any given position to make sure that a player is fully healed, or that the team has the resources to replace them, as the team did when Iker Casillas was injured last season.
While initial reports have Alonso out for three months, it is possible that the bone could heal and Alonso could be back more quickly. Most of this will have to do with his response to treatment and his body's ability to heal. Some people just heal more quickly, though there are medications that can push the body to regenerate bone more quickly. Most of these are off-label usages of drugs used to stave off osteoporosis and are seldom used in sport.
While Alonso is in the last year of his contract and has fought injuries for much of 2013, he was expected to be Ancelotti's first choice at the back of his attack-heavy formation. Losing him is a tough way to start a season and what Madrid is hoping is a new era.
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