© David Kohl-USA TODAY Sports
You would be hard-pressed to find a single person in the 49ers’ organization that expected Trent Taylor to miss the entirety of last season after suffering a Jones fracture in his right foot. His case was not a never-before-seen one, but it leans heavily in uncommon territory.
Typically, an NFL player will return to play following a Jones fracture in about 8-to-10 weeks.
That’s according to a study by Dr. Robert Anderson, Dr. Craig Lareau and Dr. Andrew Hsu. The group conducted a study from 2004 through 2014 — finalized and published in 2015 — which tracked 25 NFL players who had suffered Jones fractures and their return-to-play (defined by participation in a game) timelines. Per NFL Network’s Ian Rapoport, Anderson conducted surgery on Deebo Samuel, who suffered a Jones fracture on his left foot on Thursday.
According to the study, “76 percent of players underwent operative fixation during their first three seasons. 48 percent were diagnosed before or during their rookie (first) season.”
Of the 25 players in the study, eight, or roughly a third (32 percent), were wide receivers, with the average age being 24. It’s a young athlete’s injury, for the most part.
Samuel is 24. Taylor was 25 when he fractured his foot.
100 percent of players in the study returned to play, with three (12 percent) refracturing their toe and requiring a second surgery.
So, what is a Jones fracture? Why, despite most players having reasonable recovery times, did Taylor have such a nightmare experience? And is it likely Samuel experiences something similar?
The answers to those questions were provided by orthopedic surgeon Brian Feeley, MD, the Chief of Sports Medicine and Shoulder Surgery and a Professor in Residence at UCSF, in a phone conversation with KNBR.
A Jones fracture is one which occurs at the base of your fifth metatarsal, the pinky toe. It typically occurs in people who jump frequently, like dancers, NBA players and wide receivers, Feeley said. If you scan down the side of your foot, you’ll feel a notch. That is where the pinky toe ends, and protrudes. It’s in a minuscule, two-centimeter area analyzed by doctors differentiating it from two other types of fractures in the area.
The first, which happens right at that notch, is a “really common” avulsion fracture, when a muscle tendon rips off a piece of bone. That can be treated non-operatively. A Jones fracture is just above that. And in the area just past that is a mid-shaft fracture which tends to heal fairly easily.
Deebo Samuel Jones Fracture
*Most common in WR
*8-12 week recovery
*Performance compared to pre-injury levels ⬇️ by over 50% if the athlete returns prior to 10 weeks post-operatively
*15-20% risk of 2nd surgery
— Matthew Betz (@TheFantasyPT) June 18, 2020
The Jones fracture, however, gets poor blood supply, which tends to prevent it from healing quickly. And in order for healing to actually happen, weight-bearing needs to take place, which means standing on a broken toe. As Feeley said, it’s the most common area of the foot to break.
While the injury itself is not innately severe, the recovery process can be the most difficult among similar injuries if not treated properly or if complications arise. The combination of the area’s poor blood supply and the fact that it’s loaded with weight when people return to weight-bearing activities is the root of those issues.
“Even when it does heal, because it’s subject to high loads, it’s at considerably higher risk than other injuries for a repeat injury,” Feeley said.
But in most cases, (88 percent, according to the study), there is no need for a second surgery. While the study states the average timeline is 8-to-10 weeks for return to play, Feeley said the wider range is six-to-12 weeks for return to play, and four-to-six weeks for return to weight bearing. That second number is where Taylor’s initial timeline likely came from.
“If you’re pain free and you have X-rays or a CT scan around six-to-eight weeks that shows that the bone is healed and you’re feeling comfortable, then you can be allowed to return to sports,” Feeley said.
Taylor, unfortunately, was not in that group. Because of that poor blood supply in the area and the fact that it’s repaired with a metal screw, a material which bacteria “love to live around,” Feeley said, leaves it at high risk for infection.
“One of our most common complications of any orthopedic procedure is infection, which is hard to eradicate,” Feeley said.
While the success rate is exceedingly high — 90 to 95 percent, according to Feeley — once an infection happens, the straightforwardness of the recovery is all but lost.
“Once you have an infection where you have a problem with the hardware, instead of having a 90 percent success rate, which is what we think of as most who have Jones fractures as of having, that’s gonna drop down and once you’ve had a second surgery, third surgery, everything gets exponentially more difficult.”
The best hope for preventing infection is to ensure the screw is placed properly the first time, allowing athletes to get back to weight bearing as quickly as possible. Without putting weight on your foot, healing won’t happen effectively.
Still, there’s a balance to that. Putting weight on the injury too soon will increase the rate of failure, Feeley said, but the bone needs weight on it in order to heal. That’s why some doctors use custom orthotics and bone stimulators to increase blood supply and stimulate the bone in order to load weight as early as possible.
Taylor’s experience, as Feeley said, was just about the worst possible case.
“Worst case scenario is delayed union or an infection where you’re gonna lose the season, and then you’re gonna have to get back in shape,” Feeley said. “It’s hard, obviously, if you can’t put weight on your foot, for an athlete that requires cutting and pivoting at speed. It’s going to be hard to get yourself back into shape, but the tradeoff is if this is happening to younger players in the NFL, or in the NBA for that matter, they have more time and they have a little bit more resilience than somebody who’s 34-36.”
If all goes according to plan, Samuel will be ready at the start of the season. The earliest timeline of six weeks (July 30) would allow him to participate in training camp, which starts July 28, and the latest, of 12 weeks, would have him back September 10, three days before the 49ers’ season opener against the Arizona Cardinals. The 10-week timeline Samuel suggested on Twitter would put him at August 27 for returning to play, towards the end of training camp.