Tag Archives: nfl injuries

What’s up with the spate of foot and ankle injuries in the NFL?

25 Sep

We’re only going into the 4th week of the regular football season and already we’ve seen a huge percentage of below the knee injuries. Why? Who knows, perhaps it’s just bad luck. But we do know that the NFL team trainers have a lot to deal with this season.

Here’s a list of foot and ankle injuries suffered by NFL players so far, and this may be the biggest list we’ve seen this early in the season.

DeAngelo-Hall

DeAngelo Hall of Washington is out for the season with a ruptured Achilles tendon.

The most significant injuries, which will cause each player to miss playing time are:

DeAngelo Hall, Washington, ruptured Achilles tendon, out for the season

Robert Griffin, Washington, dislocated ankle

Kam Chancellor, Seattle, bone spurs in ankle

Geoff Schwartz, New York Giants, dislocated toe

Danny Woodhead, San Diego, high ankle sprain

Tramaine Brock, San Francisco, sprained toe

Vernon Davis, San Francisco (they’re just saying “ankle injury”)

Manti Te’o, San Diego, right foot fracture

Rod Streater, Oakland, foot fracture

Tyvon Branch, Oakland,  Jones Fracture

Jon Beason, New York Giants, foot fracture

Matt Cassel, Minnesota, fractured foot – multiple bones

Koa Misis, Miami, ankle injury

Jamaal Charles, Kansas City, high ankle sprain

Arthur Jones, Kansas City, high ankle sprain

Jonathan Goodwin, New Orleans, high ankle sprain

Matt Tobin, Philadelphia, high ankle sprain

Khaled Holmes, Indianapolis, high ankle sprain

Joe Reitz, Indianapolis, high ankle sprain

 

And there have been less serious foot and ankle injuries to:

Brandon Bair and Wesley Woodyard, Tennessee; Dri Archer, Pittsburgh;  Miles Burris, Oakland; Chris Johnson, New York Jets; Tamba Hali, Kansas City; Damien Williams, Miami; Husain Abdullah, Cyrus Gray, and Eric Berry, Kansas City, Storm Johnson, Toby Gerhart, Mickey Shuler, Paul Posluszny, and Allen Hurns, Jacksonville; T.Y. Hilton, Indianapolis; Johnathan Joseph, Garrett Graham, Andre Johnson, Houston; Calvin Johnson, Detroit; Brandon Marshall, Chicago; A.J. Green and Marvin Jones, Cincinnatti; Robert Woods, Da’Norris Searcy, and Lee Smith, Buffalo; Harry Douglas and Devin Hester, Atlanta; and Andre Ellington of Arizona.

See our point? That’s a long list, and we’re especially curious about the number of high ankle sprains. We don’t recall having ever seen that many at one time – especially in week 4.

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Jamaal Charles and Arthur Jones Out With High Ankle Sprains

19 Sep

Your fantasy league is under great duress this week.

jamaal charles high ankle sprain

Jamaal Charles doing what he does best.

High ankle sprains have become an epidemic in the NFL lately. Jamaal Charles of the Kansas City Chiefs, and Arthur Jones, Khaled Holmes, and Joe Reitz of the Indianapolis Colts are all on the bench with high ankle sprains. Charles and Jones sustained their injuries in games this week, and Holmes and Reitz have been sitting out since pre-season games in August.

How does a high ankle sprain differ from a normal ankle sprain?

In the more common lateral ankle sprain, the ligaments that surround the ankle joint are injured through an inward twisting, causing pain and swelling around the ankle. A high ankle sprain, also known as a syndesmotic sprainis an injury to the syndesmotic ligaments above the ankle which join the two bones of the lower leg together. A high ankle sprain is caused when the lower leg and foot twists out (externally rotates). See a diagram of a high ankle sprain here.

arthur jones high ankle sprain

The Colts’ Arthur Jones gets carted off the field during their game against the Eagles.

The tibia (shin bone) and fibula run from the knee down to the ankle.  If the injury is a stable high ankle sprain, the tibia and fibula stay in their normal orientation, and the athlete may be out for as little as five or six days.

If the injury is an unstable high ankle sprain, two or all three ligaments above the ankle are torn and the tibia and fibula are free to move. A podiatric surgeon may need to place a screw between the tibia and fibula to hold the bones in proper position while the ligaments heal, and may require the athlete to be sidelined for as long as 6 months(!). High ankle sprains pose a bigger challenge to healing than common ankle sprains, which is why athletic trainers are very cautious about returning an athlete to the lineup too quickly.

NY Giant Geoff Schwartz Catches Lucky Break With Dislocated Toe

27 Aug

Those of us who aren’t pro athletes just can’t appreciate how critical foot and ankle health is.

Sprained ankle? I’ll “walk it off”

Stubbed toe? I’ll wear looser shoes for a week

A little heel pain? It will pass….

You may think that professional athletic trainers are “babying” their players at times, but they know from experience that a seemingly innocuous, minor injury that’s left unattended, can develop into an injury which costs the team a championship, and end a player’s career.

geoff schwartz

Geoff Schwarts is carted off the field Friday night.

For instance, Geoff Schwartz, starting left guard for the New York Giants, was carted off the playing field last Friday night during their preseason game with the Jets. Trainers believed the toe was dislocated, but had no idea as to its severity.

A dislocated toe is nothing to take lightly, because if serious enough, it can be a season-ending injury for an athlete. Fortunately for Schwartz, tests revealed that it’s only a minor dislocation which won’t require surgery. Geoff will be back on the field by the end of September if his rehab goes as planned.

“This is just a minor setback,” Schwartz said. “I plan on attacking the rehab program so I can get back on the field as soon as possible with my teammates and help us win games.”

How your toe becomes dislocated – and what to do about it

When the ligaments and tendons which hold the toe joint together are torn, the bones move apart and out of place. This is what’s called a dislocated toe. This can be a minor injury, as in Schwartz’s case, or quite severe, as when the toe is visibly out of joint. When the joint is properly realigned, it takes about 6 weeks for the ligaments to heal.

How can you tell the difference between simply stubbing your toe, spraining it,  breaking it, or dislocating it? You probably can’t, which is why you should see a podiatrist as soon as possible after you injure it. If the toe is dislocated, you’ll feel immediate, intense pain, extreme pain if you try and bend the toe, swelling, bruising, tenderness, or numbness, and possibly a very visible deformity. Some of these symptoms are also consistent with sprains and fractures, which is why a podiatrist’s opinion is necessary.

Never – and we mean never, ever, ever try and “pop” the dislocated toe back into place by pulling on it. That’s strictly Hollywood stuff. A dislocated toe is frequently accompanied by a fracture, so if you pull on it, you can do a lot more damage. If you suspect that your toe has been dislocated, seek immediate medical attention from a podiatrist. He or she will take x-rays, make a diagnosis, and then if it is indeed dislocated, realign the toe and provide you with a walking boot to protect the toe while it heals. Physical therapy may also be recommended to get the toe back in shape after the ligaments heal.

Take your foot and ankle health as seriously as pro athletes.

Giants’ Jon Beason Sidelined With Sesamoid Injury

16 Jun

Here’s some potentially bad news for Giants fans: Middle linebacker Jon Beason injured his right foot during off season training Friday. It appears he suffered a ligament tear and a fracture of the sesamoid bone.

jon beason foot injury

Beason at work against the Redskins in 2013

“You have freak injuries,” Beason said. “I was just changing directions… the movement was a little unorthodox, I was flexing with the big toe in the ground and then I pivoted on it all the way around. It’s a movement that I often do… I literally felt like I stepped in like a sprinkler head hole. I just felt it give right away.

“I really felt that I that I had torn the extensor, which is the tendon with the muscle, it’s how your big toe functions. That would have been season-ending.”

After limping to the sidelines and huddling with the training staff, Beason was carted off the field and taken to the Hospital for Special Surgery where he underwent an array of tests: MRI, CT, and x-rays. A definitive treatment plan has yet to be announced, but Beason’s status for the Giants’ regular season opener in Detroit is up in the air, as an injury like his typically requires a 12 week recovery period.

Beason, a 3-time Pro Bowler, was drafted by the Carolina Panthers in 2007. He played only one game for the Panthers in the 2011 season when he ruptured his left achilles tendon, and in 2012, played in just four games before suffering a microfracture in his right knee, requiring surgery.

Beason was traded to the Giants in October of 2013, and played in all 12 remaining games. At the end of the season, he was second on the team with 93 tackles. The Giants re-signed him in March and expected him to be a cornerstone of their defense this year.

So what’s a sesamoid anyway?

Most bones in our bodies are connected at joints, but not the sesamoids, which are connected only to tendons or embedded in muscle. Your kneecap is the largest sesamoid in your body, and the smallest are those found in the foot, two tiny, pea-shaped bones in the front of each foot that most people are unfamiliar with until they’re injured.

Located just behind the big toe, the sesamoids act like pulleys, providing a smooth surface over which the tendons glide, increasing the leverage of the tendons controlling the big toe. The sesamoids also assist with weightbearing and elevate the bones in your biggest toe. But that’s assuming you have sesamoids – some people are born without sesamoids in their feet and experience no problems.

Read more about sesamoiditis

If you damage the sesamoid bones in your feet, you’ll feel the pain in the ball of your foot, just behind the joint of the big toe. You may simply have an irritation of the tendons around the bones – called sesamoiditis, or you may have actually broken one of the tiny bones.

If you suspect an unjury to the sesamoids, seek an evaluation from a podiatrist, the most knowledgeable physician to treat this uncommon injury. Before your appointment, stop the activity which caused the pain, take over the counter pain medicine like advil or aleve to manage the pain and soreness, and use ice to reduce swelling.

If after a diagnosis, your podiatrist confirms an injury to the sesamoid bones, she or he may recommend any of the following:

  • custom orthotics to shift your body weight off of the forefoot
  • steroid injections to relieve swelling and pain
  • immobilization with a surgical boot
  • physical therapy
  • strapping or taping the big toe
  • surgery to remove or repair the sesamoids

The podiatrists at PA Foot and Ankle Associates are experts at treating sports injuries and are the best qualified physicians to diagnose and treat uncommon injuries of the foot and ankle.

Eagles’ Todd Herremans out for season with cuboid bone foot injury

8 Nov

There goes what’s left of the Eagles’ offensive line.

todd-herremans-philadelphia-eaglesMonday night’s game against New Orleans was ugly. QB Michael Vick was sacked seven times and in the first quarter, Right Tackle Todd Herremans went out limping after he landed on the inside of his right foot with such great force that he dislocated bones all the way across the outside of his foot. Sort of like what happens when a car hits a brick wall at 50 mph – only his foot was the car.

Eagles head athletic trainer Rick Burkholder described the injury as a dislocated cuboid bone in Herremans’ right foot, in addition to a slight fracture of his fourth metatarsal, ligament damage, and a slight tendon strain.

“The best way I can describe it to you” Burkholder said, “…if you have a jigsaw puzzle and those pieces fit together real nicely. But if you put force on one side and one of those pieces pops out, it kind of takes the cardboard with it. That’s kind of what happened to that bone.”

“[On Tuesday], We took him over to the surgical center at the Navy Yard, and they numbed him from the knee down and they popped that [cuboid] bone back into place.”  To test the stability of the joint, doctors placed Herremans under anesthesia and then attempted to pop the bone back out, but it stayed in. That was good news, as it indicated that the joint was stable, which was important for their prognosis and diagnosis. Burkholder said team physicians are leaning against surgery, since the ligaments appear to be stable but strained.

Herremans, a fourth round draft pick in 2005, started his 100th career game Monday, and now joins center Jason Kelce on injured reserve.

What is the Cuboid Bone?

Cuboid-bone left footAs the name implies, the cuboid bone is cube-shaped. It’s one of the bones on the lateral (outside) side of the foot and plays an important role in keeping your foot and ankle stable so that you can walk in the unique way that humans walk. How the bones of the foot join each other is key in the gliding motion of the joints, which allow us to have that smooth foot movement from heel to toe. Without the unique spacing and stabilizing properties of the cuboid bone, your foot would be considerably stiffer and less stable and you would have much more difficulty executing that motion.

Herremans was actually very fortunate that he didn’t sustain a “Nutcracker injury” which is more typical in his circumstances. In a Nutcracker, the cuboid bone serves as the nut, can’t contain the kinetic energy that comes in from the side of the foot, and it fractures under the pressure.

A more common injury of the cuboid bone is subluxation, or ascuboid syndrome, in which the bone is pushed downward and out of place. With this injury, you might experience a dull ache along the middle of the outside of your foot, and you’ll have difficulty putting weight on it. The pain will not subside with rest or elevation.

Herremans’ Status

Burkholder said that Herremans would have to spend the next 8 weeks in a walking boot before starting physical rehab, but the Eagles do not consider Herremans’ injury career-threatening. They expect him to make a full recovery before training camp next summer. His IR status is unfortunate, as he has been the Eagles’ most consistent and versatile lineman over the last few years, and was the lone bright spot on an otherwise dismal o-line this year.

Another NFL WR down: Redskins’ Pierre Garcon’s mysterious foot injury

18 Oct

Lately, we’ve been posting about quite a few NFL athletes (and more than a few wide receivers) benched with foot and ankle injuries: Hakeem Nicks of the Giants; Santonio Holmes of the Jets; Matt Forte of the Bears; Terrell Suggs of the Ravens. Now, another wide receiver is sidelined: Pierre Garcon of the Washington Redskins.

In the 2011 offseason, Garcon was signed to a 5 year contract for $42.5 million. Thus far, he’s only played in the season opener and a handful of plays since then, due to a mysterious injury of his right foot sustained in game 1 against New Orleans.

pierre garcon washington redskins

At first it was thought Garcon had a case of the dreaded turf toe, but when that was ruled out, an MRI was ordered. Monday, Redskins coach Mike Shanahan revealed that Garcon has an inflamed capsule underneath the joint of his second toe. “That toe is quite sore,”  Shanahan said. “You could see when he’s pushing off when he goes downfield he’s just not anywhere close to full speed.”

Garcon’s injury is called capsulitis. The capsule is the fluid filled outer covering that joins two bones to make a joint. There are five of these joints in each foot, joining the metatarsals to the toe bones (phalanges). The capsule under the second toe, where Garcon is reported to have his injury, is the most common capsule to become inflamed.

Those who suffer this kind of injury will generally report pain, swelling, redness, and a feeling like they’re walking on a stone. If left untreated, painful calluses may develop. Capsulitis can be difficult to diagnose because of other related structures in the forefoot that can also become inflamed from biomechanical problems. It is frequently misdiagnosed as bursitis.toe capsulitis location

Why do so many wide receivers suffer foot injuries?

1. Wide Receivers demand a lot of their feet

Anyone who’s watched an NFL game knows that a wide receiver frequently pivots sharply when he turns to catch the ball. He  sometimes precedes that action with a fake motion in the opposite direction to shake off the man covering him. This position also requires very significant, sudden bursts of power (jumping and sprinting). The lateral motion and quick power is extremely demanding on every part of the foot and ankle and one step in the wrong direction, or one bad landing after making the catch, and the foot, toe, or ankle twists sharply, causing a sprain, irritation, or fracture. And that doesn’t even include a teammate or opposing player accidentally landing on your foot. Often, the injuries are an accumulation of overuse, as in plantar fasciitis, or achilles tendonitis.

2. The playing surface: synthetic vs natural turf

An additional problem is the playing surface. Eleven NFL teams now use a synthetic turf called FieldTurf in their stadiums. While  it requires no irrigation or cutting, synthetic turf is responsible for more athletic injuries because it doesn’t have the same “spring” as grass. Grass and soil actually give a little bit underfoot, allowing a player’s foot to properly twist and turn, whereas synthetic turf does not.

In one of three NFL injury studies, researchers found that National Football League players were significantly more likely to injure their legs and feet on FieldTurf than on grass. According to Elliott Hershman, MD, of Lenox Hill Hospital in New York City, “NFL players were 27% more likely to sustain a lower extremity injury when the game was played on artificial FieldTurf instead of the real thing”.  More specifically, “there was an 88% increased risk of an injury to the anterior cruciate ligament (ACL) and a 32% increased risk of an eversion ankle sprain (when the ankle rolls too far inwards) when playing on FieldTurf”, Hershman reported at an American Academy of Orthopaedic Surgeons meeting.

University of Missouri turfgrass expert Brad Fresenburg has done comparative tests on natural turf and synthetic turf. Fresenburg says that these tests show “increased potential pressure on joints and bones from the inability of a fully planted cleat-wearing foot to divot or twist out, an action that releases force. The traction on synthetic turf is much greater”, he said. “Most people see [divots and ripped out grass] as damaged turf. I like to say those divots are a sign that the field is doing its job – yielding to the athletes’ cleats.”

Garcon described his ongoing foot injury as frustrating, and is determined not to let himself get discouraged by the healing process. He also understands that he risks another setback if he returns to action before he’s fully healed.  “It does suck not being able to play, but you can’t sit around and mope about it,” said Garcon. “I need my toes to be 100 percent… If it’s not 100 percent, I can’t really give it any power or force.”

With Garcon out, first-year pro Aldrick Robinson is expected to take his place. Robinson was a sixth-round draft pick out of Southern Methodist University in 2011 and played on the Redskins’ practice squad last season.

Jets’ Santonio Holmes out for season with Lisfranc foot injury

3 Oct

New York Jets Wide Receiver Santonio Holmes was having a great 2012 season. He led the Jets with 20 catches for 272 yards and one touchdown. He and Quarterback Mark Sanchez were in sync, having their best game together two weeks ago in Miami when Holmes caught nine passes for 147 yards.

santonio holmes lisfranc foot injury

Holmes crumples on the field Sunday night

But Sunday night against San Francisco, Holmes went down on the first play of the fourth quarter when he dropped to the turf after making a catch. His left leg buckled, and on the way down he grabbed his knee and dropped the ball, a fumble, which was scooped up by Carlos Rogers who ran it back for a touchdown. Jets lose 34-0.

After x-rays, an MRI, and a few professional medical opinions, today the Jets placed Holmes on injured reserve with a Lisfranc (pronounced Liz Frank) injury to his left foot, which ends his season and will likely dog him for the rest of his career. That leaves the Jets without their most valuable offensive player. Stepping in for Holmes will be veteran wide receiver Jason Hill, a 2007 third round draft pick by the 49ers.

What is a Lisfranc injury?

The middle region of your foot is called the midfoot, where a cluster of small bones forms an arch on the top of your foot. From this cluster, five long bones, the metatarsals, extend to the toes. The metatarsal bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal and a twisting fall can break or dislocate these bones.
Lisfranc foot fracture xray
Lisfranc injuries occur when bones in the midfoot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, and involve many joints and bones in the region.  A Lisfranc injury is frequently mistaken for a sprain, especially if the injury results from a twist and fall, but this injury is quite serious and may require surgery and many months to heal.

Women are susceptible to Lisfranc injuries on falls from high heels. The injury is named after the French doctor who first diagnosed it in 1815.

A Lisfranc injury usually occurs when a heavy object falls onto the midfoot, such as when the foot is run over by a car or truck, or when a fellow athlete lands on your foot. In Holmes’ case, no contact was made with another player, so the injury probably occurred when his foot twisted too far in one direction while pointing downward.

At this time, the Jets aren’t revealing how severe Holmes’ injury is, but since they stated that Holmes will undergo surgery, a fracture or dislocation is probably the culprit. If surgery is mandated, the bones may be fixed in place with a temporary screw or K-wire (a thin, rigid surgical wire used to stabilize bones). Holmes won’t be able to bear any weight on his foot for at least 6 weeks.

Obviously, that’s a big loss for us,” coach Rex Ryan said. “Santonio’s one of the top receivers in the game, and it is a big loss.” 

Holmes helped Pittsburgh win the Super Bowl in 2009 and played a key role in the Jets’ run to their second consecutive AFC championship game in 2010. New York re-signed him to a five-year, $45 million contract last year.

“My understanding is that he’s going to be back and make a full recovery,” Ryan said.

What is Turf Toe?

21 Sep

turf toe diagramTurf Toe is considered a relatively minor sports injury, but it can be quite painful. Known as a Metatarsophalangeal joint sprain in medical jargon, turf toe is basically an injury to the joint and connective tissue between the foot and the big toe.

Most commonly associated with football players who play on artificial turf, it also affects athletes in other sports including soccer, basketball, wrestling, and gymnastics.  Turf  toe is usually the result of jamming the big toe into the ground, bending it backward beyond its normal limits, or repeatedly and forcefully pushing off the big toe as one would do when running or jumping. Many NFL players routinely have their toes taped before games to prevent this injury.

According to Russell Warren, a professor of orthopedics and the team physician for the New York Giants,

“I see it in linemen—particularly the ones on the ends of the line. If that player gets overpowered and his knee is down on the turf and his foot is out behind him, and he falls back on his foot or somebody else falls on it, smashing the toe into the ground and hyperextending it.

“The wrenching motions cause inflammation—swelling and stiffness—of the joint where the toe attaches to the rest of the foot, leading to difficulty moving the toe. We’ll turf toe in football illustrationoften try to reduce the swelling and get movement in the joint back by icing the injury or treating it with ultrasound—which stimulates the tissue and causes increased blood flow to the area to speed healing. If motion around the joint is lost, turf toe can become a chronic problem, sidelining some players for up to a month.

“In extreme cases, players can tear ligaments at the joint between the toe and the foot, sprain the joint or injure cartilage underneath the toe, separating it from the bone—by cracking or splitting it. In rare cases, two little bones on the balls of your feet behind the big toe called sesamoids—which are like little knee caps—can stiffen and begin throbbing or, worst-case scenario, fracture.

“If a player gets turf toe—and we don’t make any protective changes—the chance of him sustaining stress fractures and breaks in his foot increases. To protect against re-aggravating the injury, we’ll get them firmer shoes or put a thin, steel plate in the bottom of the shoe to take some of the flexibility out of the tip of the shoe.

Turf Toe symptoms

You know you have turf toe when there’s pain, swelling, and limited joint movement at the base of one of your big toes. The symptoms usually develop slowly and get worse over time. But if it’s caused by a sudden forceful motion, sometimes a “pop” can be felt and the injury will be immediately painful, with symptoms worsening inside of 24 hours.

Turf Toe treatment

It typically takes two to three weeks for turf toe pain to subside. In order to give your toe time to heal, the foot must be rested and the joint protected from further injury. The basic treatment for turf toe is the simple and reliable R.I.C.E.: Rest,Ice, Compression, and Elevation.  Your podiatrist may recommend an over-the-counter anti-inflammatory/pain reliever such as ibuprofen (Advil) or naproxen sodium (Aleve), and may tape or strap the big toe to the toe aside it, or immobilize the foot in a cast or walking boot.  In severe cases, surgery may be necessary.  Physical therapy may be recommended after immobilization to re-establish range of motion, strength, and conditioning of the injured toe.

One goal of treatment should be to evaluate why the injury occurred and to take steps to keep it from re-occurring. Your podiatrist may recommend wearing shoes with better support to keep the toe joint protected from excessive bending and force, and may also recommend using custom designed orthotics. A physical therapist or a specialist in sports medicine can also work with you on developing training techniques to help reduce the chance of re-injury.

Unfortunately, turf toe often returns and can reduce the long-term function of the big toe joint. Arthritis of the big toe is quite common in those who suffer repeated turf injuries or trauma to the big toe joint.

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