An Educated Guesses Show Production
An EDUCATED Guesses guide to being an injury savvy owner and dominating your other leagues.
Disclaimer: This information is based on the current medical research available to the public. In no way shape or form am I telling you that the information being provided is the end all be all. Remember I am not a medical doctor, but I have a medical background which allows me to interpret the medical information given to us (the public) as well as give you some insight as to a player’s ability to return to play from the injury. ** Remember this information should not be substituted over information from your medical doctor. If you suspect you have an injury please consult your physician**
This is what I hope to be a series of articles helping owners make informed decisions on players that will hopefully help you in future drafts or in determining your week to week starters. As much as I want to keep this information to myself, I want to do my part in making this league the very best and that means providing information that fellow league members may not have access to. Hopefully you gain some useful information from these articles…unless you’re El raven and have a difficult time reading…in which case go “through” yourself off a cliff.
Davy Jones Hurt Locker
Introduction
Alright! So, I am not great at coming up with an amazing title or a solid hook to grab the reader’s attention. GET OVER IT! What I will say is that I have been working on this article for some time now and I am really excited to share this with the league. This has been one of my personal favorite injuries to study and the results were the complete opposite of what I expected to see initially. So let’s get going!
Today we are going to be examining a foot injury that has been plaguing some of the top wide receivers in the fantasy football world. The dreaded 5th metatarsal fracture, otherwise known as the Jones fracture. There are several owners in this league that are going to want to really pay attention to this injury examination and player outlook as their season may hinge on these players staying healthy and maintaining a high level of production.
I am going to start this off by saying the foot is terribly complex, even more so than the knee, and grossly underestimated by the lay person as to its complete function until they actually suffer an injury. I am not sure if one person in this league could actually say they have not suffered a foot injury at some point in their life (well….maybe one, but let’s all be nice to Luke Monster as we know the worst he’s ever been through was breaking a freshly painted nail). If you have experienced a foot injury, then you know what I mean when I say you do not truly understand how important your foot until it hurts with every step or you are walking in a brace. Trust me, it sucks.
Anatomy
First and foremost, the foot consists of 26 bones and is divided into three regions: the forefoot, midfoot, and rearfoot. This article will be examining a bony prominence that emerges from the 5th metatarsal, located in the forefoot; more commonly referred to by the media as “the outside part of your foot”. This bone forms the outer edge of the foot and serves as an attachment site for a few muscles of your lower leg and foot. For this article we are going to be focusing on the part highlighted in Figure 1 (Red circle). Do to the high amount of stresses this area undergoes during athletic movements not only do we see issues with Jones fracture itself, but also stress fractures (I’ll explain more in a bit).
A true Jones fracture involves the very end of the bone, aka the part sticking out closer to the heel bone. This type of fracture is different than just a stress fracture of the fifth metatarsal as they can occur anywhere along the metatarsal itself. I am bringing up the stress fractures to the fifth metatarsal because, as you will see when you review the table of players at the end of the article, many of the players with stress fractures get lumped with the Jones Fracture group. While these are technically both fractures of the fifth metatarsal, they both are very different types of injuries. Typically, a Jones fracture is considered an “acute” injury, meaning it is a one-time instance that caused the injury, whereas a stress fracture is considered a “chronic” injury or something that is the result of repetitive damage that eventually leads to the fracture line occurring along the bone. You as an owner need to recognize the difference because they can result in difference treatment strategies taken by both the player and team (Chuckpaiwong, Queen, Easley, & Nunley, 2008).
Just like we saw in the examination of the meniscus of the knee, this region of the body has a very poor blood supply and thus is prone to not healing very well without surgical intervention. Because of this, it is common practice to forgo conservative treatment and opt for surgical intervention in high caliber athletics. This gives the athlete a better chance of returning to play more quickly and for the appropriate healing to occur.
Figure 1
Mechanism of Injury
Picture this. It’s a nice sunny fall day on a Sunday afternoon and your favorite team is on and they are giving it to the worthless San Francisco 49ers. Suddenly a news report pops up on your cell phone stating “Watch now as (Insert your top WR here) goes down trying to make a catch in the endzone. Player X was unable to get off the field under his own power. Carted off the field. Click here for video.” Your heart stops for a moment as you click the link. You watch the video to see if you can glean anything from the video to give you an idea of the severity of the injury before you hop onto Twitter to see all the negative season ending posts or to see the epic rant about to ensue by @friscojosh.
Here I will do my best to explain what you should be looking for on the video to give you an idea that your player may have suffered this injury before you wait for the team to announce anything. When you are looking at the video desperately trying to make it slow motion or trying to see a distinct injury (Refer to Figure 2 If you didn’t see this. This is an obvious injury)
Figure 2
you should be looking for the following. This injury will be VERY tough to see on film alone, but if you see the correct mechanism of injury you can go ahead and add it to your list of potential injuries. If you see the player’s ankle roll inward (Figure 3) like a traditional ankle be concerned!
Figure 3
The next thing you want to look for is whether the player was able to walk off the field on their own and were they able to put any weight on the foot and walk more than 3 feet without a look of discomfort. This is what will help you distinguish if it’s a traditional ankle sprain or something worse. As with fractures, individuals may have more difficulty walking without assistance or putting any weight on it. If you’re extremely lucky and the camera stays on the player while they are on the bench or treatment table and you see the medical staff touching the outer aspect of the foot and the player is grimacing in pain, be concerned. Be very, very concerned. (Figure 4)
Figure 4 – In this photo it is clear that the Athletic Trainers* are taping the ankle. However, one thing that I see is Dez pointing to the outer part of his foot. The thing with this type of tape job is that it can put pressure on the 5th metatarsal. Which, if there is a fracture there, will be pretty uncomfortable for the athlete and they will definitely let you know!
Surgical Procedures
When surgery is chosen by the medical staff and/or the player, it is actually a simple surgery. An incision is made along the outside of the foot along the bone so that the surgeon gains access to the fracture site. A screw is then placed inside the shaft of the bone (Figure 5a and 5b) so that fractured part of the bone is squeezed back together with the rest of the metatarsal. After the screw is securely in place, a bone graft is performed to help encourage healing around the fracture site. This is done because, as I said earlier, this area does not heal very well due to a lack of blood flow. The foot is then splinted in place until the stitches are removed (Roche & Calder, 2013).
Figure 5a
Figure 5b – This photo is for you Miami Brad! I know you really want to see the details.
What the research says
Jones fractures require early surgical intervention especially in the active population (so Chicago Nic you should be good without surgery here buddy). Usually after surgical intervention the expected return to play time is 8 weeks.(Lareau, Hsu, & Anderson, 2015; Roche & Calder, 2013; Zwitser & Breederveld, 2010)
Players with injury
| Name | Surgery Date | Date of Return | Surgery | Notes | Stats | ||
| Dez Bryant | 9/14/2015 | 10/28/2015 – 6 weeks | Surgery* | Returned a bit earlier than expected, but fell into the bone healing time frame of 4-6 weeks. **Had a second surgery to replace a bone graft in his foot. However it does not say if he had another repair. | 2014: 16 games / 88 rec/ 1,320 yd/ 15.0 avg / 82.5 ydsG/ 16 TD | 2015: 9 games/31 rec/401 yd/12.9 avg/ 44.6 ydsG/3 TD | 2016: 13 games/50 rec. 796 yd/15/9 avg/ 61.2 ydsG/ 8 TD |
| Julio Jones | 10/7/2013 | 7/23/2014 – 39 weeks | Surgery* 2nd injury to the same bone | Reinjured the same foot during a game. Underwent the surgical repair to the fractured bone. | 2013: 5 games/ 41 rec/ 580 yd/ 14.1 avg yd/ 116.0 ydsG/ 2 TD | 2014: 15 games (missed 1 game due to hip injury. Not related to the foot injury) / 104 rec/ 1,593 yd/ 15.3 avg/ 106.2 ydsG/ 6TD | 2015: 16 games/ 136 rec/ 1,871 yds/ 13.8 avg/ 116.9 ydsG/ 8 TD |
| Julio Jones | 3/5/2011 | 5/7/2011 (best date available) – 9 weeks | Surgery | Fracture during his junior year at Alabama. Completed NFL combine prior to having surgery. Played the entire rookie season without issues. Missed 2 games due to hamstring injury | 2011 (rookie season): 13 games/54 rec/959 yd/17.3 avg yd/73.8 ydsG/8 TD | 2012: 16 games/79 rec/1,198 yd/15.2 avg/ 74.9 ydsG/10 TD | |
| Julian Edelman | 11/15/2015 | 1/16/2016 – 8 weeks | Surgery | Fractured during a game against the NYG in week 10. Was cleared to play January 16th 2016 in the divisional round against KC. Note that his clearence came right on the edge of the time frame that it would normaly take to heal. Played game with a steel plate inserted into his shoe to prevent flexion of his foot. **Had second procedure May 11th to reinsert the screw into his foot. | 2015: 9 games/ 61 rec/ 692 yds/ 11.3 avg yd/ 76.9 ydsG/ 7 TD | 2016: 16 games/ 98 rec/ 1,106 yds/ 11.3 avg/ 69.1 ydG/ 3 TD | |
| Devonte Parker | 6/5/2015 | 9/3/2015 – 12 weeks | Surgery | Had surgical procedure to replace the screw in his surgically repaired foot from college. Foot troubles plagued him all season. Reaggravated the injury during week 8 loss to NE. Missed the next 2 games. | 2015: 14 games/ 26 rec/ 494 yd/ 19.0 avg/ 35.3 ydsG/ 3 TD | 2016: 15 games/ 56 rec/ 744 yd/ 13.3 avg/ 49.6 ydsG/ 4 TD | |
| Devonte Parker | 8/22/2014 | 10/18/2014 – 8 weeks **Cant find a specific date since it is college and injury info is more controlled | Surgery | Fractured his fifth metatarsal during practice and missed the first 7 games of the season | 2014: 6 games/ 43 rec/ 855 yds/ 19.9 avg/ 5 TD | ||
| Sammy Watkins | 5/16/2016 | 7/8/2016 – 7 weeks **First video of sammy running surfaces. | Surgery | Suffered a Jones fracture during the offseason which required surgery. Was not able to return to form and was placed on IR until week 12 (11/27/2016). **Had second foot surgery this offseason to help with issues that were a result from the first surgery. | 2016: 8 games/ 28 rec/ 430 yd/ 15.4 avg/ 53.8 ydsG/ 2 TD | ||
| Marvin Jones | 8/9/2014 | Unknown. Was placed on IR for 2014. Returned to full participation 2015 | Surgery | Fractured his fifth metatarsal resulting in surgery. Orignally it was thought he could return week 5 during a bye week, however he was never able to return to true form during the 2014 season. Placed on IR. | 2014: NO GAMES | 2015: 16 games/ 65 rec/ 816 yd/ 12.6 avg/ 51.0 ydsG/ 4 TD | 2016: 15 games/ 55 rec/ 930 yd/ 16.9 avg/ 62.0 ydsG/ 4 TD |
| Hakeem Nicks | 5/24/2012 | No offical return date. One source did have a 14 week time table for return to activites | Surgery | Fractured his foot during OTA’s. Missed most of the offseason. Played in the final preseason game. Missed some games in 2012 season, but looks like it was not due to any issues with his foot surgery. | 2012: 13 games/ 53 rec/ 682 yds/ 13.1 avg/ 53.2 ydsG/ 3 TD | 2013: 15 games/ 56 rec/ 896 yd/ 16.0 avg/ 59.7 ydsG/ 0 TD | 2014: 6 games/ 38 rec/ 405 yds/ 10.7 avg/ 25.3 ydsG/ 4 TD |
| Michael Crabtree (2009) | Unknown | Unkown | Surgery | This was an interesting case. Here we have another player who had a stress fracture and not a true jones fracture. Crabtress stated at the draft that he had been dealing with the issue for some time. He did not participate in the combine. He still had a screw inserted into his 5th metatarsal that is the standard in jones fracture open surgery’s | 2009: 11 games/ 48 rec/ 625 yd/ 13.0 avg/ 56.8 ydsG/ 2 TD | 2010: 16 games/ 55 rec/ 741 yd/ 13.5 avg/ 46.3 ydsG/ 6 TD | 2011: 15 games/ 72 rec/ 874 yd/ 12.1 avg/ 58.3 ydsG/ 4 TD |
| Allen Robinson | 11/11/2014 | 6/1/2015 – 28 weeks | Surgery | Allen Robinson suffered a stress fracture in almost the same area. So not a true jones fracture, but worth mentioning. Underwent same surgery as a traditional jones fracture. | 2014: 10 games/ 48 rec/ 548 yds/ 11.4 avg/ 54.8 ydsG/ 2 TD | 2015: 16 games/ 80 rec/ 1,400 yd/ 17.5 avg/ 87.5 ydsG/ 14 TD | 2016: 16 games/ 73 rec/ 883/ 12.1 avg/ 55.2 ydsG/ 6 TD |
Observations
When looking at the table above we see that most of the missed playing time falls within the typical window of healing that comes with bone injuries (6-8 weeks). However, if you were to average out the missed time, it is around 14 weeks! One thing to note is this value has both the pregnancy time frame that occurred with Julio Jones second injury and a second outlier of Allen Robinson’s stress fracture injury. Now both Allen Robinson’s and Julio Jones’s initial injury occurred during the season and the teams were not in any rush to return them, or they had complications with their foot that lasted longer than what was expected. If we remove both of those individual players then we see a much more reasonable average time missed of 8.33 weeks (“Repeating of course” – Travis).
Even the research agrees that the average return to play is around 8-10 weeks (Lareau et al., 2015; Roche & Calder, 2013). What seems to be the bigger trend I see from the table is that often players will have a second surgery after the first repair. So, this tends to be an injury that lingers into the offseason and potentially into the first year of returning to play. We didn’t see Dez Bryant affected by it during the 2016 campaign, but that is likely due to the fact that he actually had the off-season to rest.
When you look at the stats, though, you do not see much of a drop in production during year one after the injury. In fact, it seems like most players bounce back fairly well. My guess is if they do not have any residual foot pain that this injury tends to not to have a negative impact on overall production. My word of warning based on all this player research is that when a player is complaining about the foot pain lingering, they are going to lose production. Just look at what happened with Dez Bryant when the Cowboys tried rushing him back too soon (6 weeks). But the opposite case could be made with a player like Julian Edelman who rested the full 8 weeks and returned to the playoffs with 17 receptions and 153 yards receiving.
Conclusion
When I first decided to research this injury, I thought it would end up having more severe consequences. However, after analyzing the table and diving into the research I will have to admit I was quite surprised to see the results. “But Sebastian? You only looked at wide receivers! What about the other positions?!” Correct! This article ended up only examining wide receivers and here is my reasoning for that: I could only find Ahmad Bradshaw as an example for the running backs and his injury was a stress fracture of the fifth, which he didn’t get surgery on. So, for the sake of this article I threw his data out faster than Houston Peru hitting the accept trade button on his email. I was lucky to find a newer article from 2016 that helped make me feel better about leaving out the other positions. In the article by Lareau et al. they examined 25 NFL players who sustained this injury to see what factors affected their return to play (Lareau et al., 2015). Of the players involved 32% played the position of wide receiver with the next two being linebacker and tight end with 16% each. So, we can say that this is more of a wide receiver injury than other offensive positions.
When looking at the progress of players returning there are a few things to be aware of as an owner. First, is the player moving well during straight line running? This is going to be the first progression of the rehab process. If you hear that they have not achieved straight line running then you should be worried that they are not tolerating the weight bearing process very well. Second, after the player has graduated from straight line running, how are they handling their cuts? When you watch the videos on Twitter, does it look like they are planting and propelling out of their cuts? Or does it look like the player is favoring their injured foot (Figure 6). Here is where you’re going to get the most information of out the player. I’d say when working with wide outs specifically, they rely a lot on quick lateral movements, especially when trying to get off the line. So, if they are not moving well here then it doesn’t matter how fast they are running down the field. They have to be able to shake the defender first. Lastly, I think it’s important to monitor for any residual foot pain. If they return to the injury report with residual foot pain, that should be a red flag for an owner. This is the point where you might want to seek out another player to fill the void on your team.
Figure 6
I don’t think this is an overall death sentence any more, especially since I read a lot of articles dealing with the best practices of surgery and how they have improved the surgery success rate. So don’t think that player is done just because they sustained a Jones fracture or a stress fracture. It is very likely that they will return and have almost no impact on the following year’s production.
Thanks for reading! Yours truly,
Sebastian Thunderbucket
References
Chuckpaiwong, B., Queen, R. M., Easley, M. E., & Nunley, J. A. (2008). Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clinical Orthopaedics and Related Research, 466(8), 1966–1970. https://doi.org/10.1007/s11999-008-0222-7
Lareau, C. R., Hsu, A. R., & Anderson, R. B. (2015). Return to Play in National Football League Players After Operative Jones Fracture Treatment. Foot & Ankle International, 8–16. https://doi.org/10.1177/1071100715603983
Roche, A. J., & Calder, J. D. F. (2013). Treatment and return to sport following a Jones fracture of the fifth metatarsal: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 21(6), 1307–1315. https://doi.org/10.1007/s00167-012-2138-8
Zwitser, E. W., & Breederveld, R. S. (2010). Fractures of the fifth metatarsal; diagnosis and treatment. Injury, 41(6), 555–562. https://doi.org/10.1016/j.injury.2009.05.035