James Maddison has suffered another injury setback in a gut-wrenching blow for the Tottenham midfielder.

Maddison, who missed nearly the entirety of last season with an ACL tear, was forced off in Spurs’ London derby with Chelsea on Saturday afternoon.

He went down soon after the second half got underway at Stamford Bridge, crouching and looking to the bench before hitting the deck as his team-mates signalled team doctors onto the pitch.

Maddison walked off the pitch visibly dejected and was replaced by former Chelsea midfielder Conor Gallagher, who was booed as he entered play.

He went straight down the tunnel after being substituted, receiving a pat on the back from opposition manager Xabi Alonso.

Maddison has had his entire Tottenham career plagued by fitness issues and only made his first start since May 2025 against Coventry, when the midfielder scored and starred in a 3-1 win - the club’s first of the season.

He missed 24 games in his debut campaign in north London due to an array of issues before suffering a serious knee injury last term, which ruled him out for eight months.

The 29-year-old suffered an early injury scare this season when he was forced off in the damning opening day defeat to Brentford due to a shoulder issue, though this setback wasn’t as bad as initially feared.

However, Roberto De Zerbi will now face another nervous wait to learn the extent of Maddison’s latest injury, compiling Tottenham’s woes in the medical department.

Several key players were missing for the trip to Chelsea, with Destiny Udogie missing while Tosin Adarabioyo was unable to recover in time to face his former club. Pedro Porro could only start on the bench.

But despite a growing injury crisis, De Zerbi defended Tottenham’s medical team, saying: “It’s football. I am convinced our medical staff this season is high level.

“I follow them. I believe in them. I have big confidence because I know how they are working.

“I think they are good enough to believe in them. Nothing more. We are suffering a normal situation in football.”

De Zerbi will be expected to provide an update on Maddison after full-time at Stamford Bridge.