NAILED: Sachin Tendulkar’s rare injury can also affect ballet dancers and high jumpersIf there’s a body part more obsessed over than the prime minister’s knee, it must be Sachin Tendulkar’s toe.Already foreheads are furrowed as India’s most popular athlete has gone missing from action, a fractured toe taking him out,NAILED: Sachin Tendulkar’s rare injury can also affect ballet dancers and high jumpersIf there’s a body part more obsessed over than the prime minister’s knee, it must be Sachin Tendulkar’s toe.Already foreheads are furrowed as India’s most popular athlete has gone missing from action, a fractured toe taking him out of the three-Test series against Sri Lanka. Injuries to athletes are part of their job profile but every time Tendulkar winces, it would seem all of India feels the pain.As the team began its first Test tour in 12 years without the 28-year-old Mumbai batsman, he appeared on television asking for all Indians to “pray” for him, little knowing that cricket-crazy citizens are already halfway through their Hail Marys.It has been a worrying few weeks for Tendulkar and his doctor Anant Joshi, with the clamour for information growing: what exactly is the injury, how long will it take to heal, will he be the same player again? “Sachin is just another human being. Your fracture and mine take six weeks to heal. So will his,” Joshi wearily says.But Tendulkar’s injury is not any routine fracture, not only because it has affected the cricketer. The problem began on July 4, during the last league match of the triseries in Zimbabwe. When Tendulkar struck the ball and set off for a run, he heard a “click” in his right toe and felt a pain. It was forgotten quickly and he scored an unbeaten 122, leading India to a six-wicket victory.Later that day Tendulkar had the foot X-rayed, but the results showed nothing. He was then cleared to play the final, which India lost. On his return to Mumbai, when the pain persisted, Tendulkar went to sports medicine specialist Joshi. On July 17, Joshi took the player for an isotope bone scan of his foot at Hinduja Hospital. The scan detects fractured bones by showing them as “hot spots”.Tendulkar’s bone scan lit up an area the size of a 25 paise coin on his toe – and a CT scan of the foot revealed a horizontal crack in the medial sesamoid bone, a tiny structure around the size of the nail of the little finger. The bone, embedded inside the muscle tendons at the base of the great toe, acts like a lever arm for the tendons to flex the toe.The fracture took place when Tendulkar heard the “click” – the sound, most likely, was the tiny bone snapping. Tendulkar himself suspects there could have been more pressure on the area due to the spike-studded sole of his custom-made Adidas shoes.advertisementOne of the seven spikes in the shoe is located directly below the sesamoid bone of the great toe. The pressure from the take-off for the run, which experts reckon puts between three to five times the body weight on one foot, could have been centered on the tiny bone and fractured it.The sesamoid bones, strictly speaking, are not even bones. Made up of thick cartilaginous tissue, sesamoid bones are mostly found in the lower limbs and are not included among the 206 bones of the human body. Injuries to these bones are rare and given only a passing mention in medical tomes – even the best podiatrists and orthopaedic surgeons come across only four or five cases.Injuries usually occur after an activity where tremendous pressure is placed on the feet and toes – ballet dancers and athletes like high jumpers and basketballers are more prone. What has puzzled many people is the time taken between the first sign of trouble and the first scan – nearly two weeks. Says Dr P.S.M. Chandran, director of sports medicine, Sports Authority of India: “A negative X-ray is not an indication that all is well. You shouldn’t leave anything to chance with a top-class sportsman.”Click here to EnlargeTendulkar’s doctors, suspecting sesamoiditis (the inflammation of the sesamoid), decided to give the injury three more weeks to heal before delivering a verdict. The hope was that the foot would have healed enough to give Tendulkar the chance to play the Test series. “I don’t mind missing the one-dayers, but please ensure I can make it for the Test series,” he told Dr B.A. Krishna, chief of nuclear medicine at Hinduja Hospital.The second round of scans, however, showed an inflammation around the affected area with little sign of healing. Moreover, Tendulkar winced in pain when Joshi probed the area near the toe. The verdict was out.”Sachin could have played the Test series only at the risk of further injury. And even then he wouldn’t have been able to give a hundred per cent,” says Joshi. For India’s most prolific run-getter in both forms of the game, the injury now means completely resting the toe for between six to eight weeks, to allow the bone to heal completely. “He won’t be playing cricket at least until the end of September,” says Joshi. Surgery, the final option, isn’t being thought of just yet.Tendulkar now has to wear cushioned sandals and can walk and drive his Mercedes without pain. Experts in the US are being consulted for designing rigid-soled orthotic footwear. All his footwear – from sneakers to ordinary slippers – will be retrofitted with these devices, most of them fitted internally to lift the injured area off the floor.advertisementHe will have to wear this special footwear for at least six months after he resumes playing. Joshi has also devised an an “active rest” exercise regimen, for every part of his body, excluding the lower limbs. “Sportsmen like him cannot afford to rest completely for so long,” Joshi says. The good news, he says, is that once the fracture heals, chances of a recurrence are slim.In recent weeks, Tendulkar was surrounded by plenty of conspiracy theories about a difficult relationship with current captain Sourav Ganguly and his wish to regain the captaincy. They have all been driven underground and rendered unimportant for the time being as the only current cricketer in Sir Donald Bradman’s all-time World XI begins his fight for fitness and the chance to return to the field to do what he did best: go out and bat for India.