David Beckham's torn Achilles' tendon is hardly surprising for an elite athlete.
The Achilles' tendon connects the calf muscle to the bone in the heel and is the most commonly torn tendon in the body. The tendon is usually torn when the leg is straight and the calf muscle contracts. It typically takes several months for athletes to fully recover.
"With Beckham, you never say never, but if it's a complete tear, it's very unlikely he'll be fit enough for the World Cup," said Jonathan Rees, a sports medicine expert and spokesman for the British Association of Sport and Exercise Medicine.
"With early surgery, Beckham might get back into training in three months' time, but that wouldn't give him enough time to be match fit for June."
A person familiar with the injury told The Associated Press he will miss the World Cup "for sure." The person spoke on condition of anonymity because an announcement had not been made. Beckham is to have surgery in Finland on Monday or Tuesday.
Doctors said if the 34-year-old star had only partially torn his Achilles' tendon, there was a slight possibility he might be ready to play in South Africa.
"You can start rehabilitation earlier and be much more aggressive," said Dr. Victor Khabie, chief of orthopedic surgery and sports medicine at Northern Westchester Hospital in New York and a former assistant team physician for the Los Angeles Galaxy, Beckham's Major League Soccer team.
Khabie said there's a "small chance" Beckham could be ready for the World Cup, but it's "still not a great chance."
Tearing the Achilles tendon can happen without major incident, particularly in athletes whose bodies are under the continual stress of training. Beckham has had little time off, playing for the Galaxy and then going on loan with AC Milan in Italy.
The injury is most common in tennis, soccer, basketball and running. A study published this year found that one third of NFL players who hurt their Achilles' tendon never played professionally again.
On Sunday, Beckham was by himself when he began hopping on his right leg and grimacing during AC Milan's 1-0 victory over Chievo Verona.
"With the Achilles' tendon, you can have a lot of wear and tear happening over your career so the tendon itself is weakened," Rees explained. "The final event that tears it can be quite innocuous."
Beckham was in tears after the injury and was carried off the field on a stretcher. Khabie said that was consistent with the pain of a complete tear.
"It feels like someone kicking you in the back of the heel very hard, and if you are in severe pain, it's likely the tendon has snapped," he said.
People who tear their Achilles' tendon have major swelling and are unable to put weight on their ankle or foot. Beckham generally kicks the ball with his right foot.
Certain medications increase the risk of tearing the Achilles' tendon, like antibiotics or medicines to reduce inflammation like corticosteroids. It is not known of Beckham was on such treatment.
Doctors typically fix torn Achilles' tendons with surgery. After the operation, patients are outfitted with a cast or brace to help the tendon heal, for about six to eight weeks.
Khabie said Beckham would likely want to be fully recovered before resuming play, since reinjuring the tendon could end his career entirely.
"It might put him out of the World Cup, but he could be back to form in about a year or less," Khabie said.
