Last February, a broken foot prevented former University of Notre Dame defensive lineman Stephon Tuitt from participating in the NFL Scouting Combine.
According to NFL.com's Daniel Jeremiah, doctors diagnosed a Jones fracture in his left foot during combine medical exams and, as a result, did not clear him to participate. At the time, Jeremiah's source projected a six-to-eight week recovery following surgery.
If such a timeline holds true, Tuitt may be returning to action very soon. However, even "small" Jones fractures require precise management and are at significant risk of complications, and as such, a six-to-eight week recovery may prove optimistic.
A closer look at the injury and its relevant anatomy shows why.
Within the foot, dozens of bones, ligaments and muscles coordinate the numerous complex motions of the toes, foot and ankle.
When an outside force applies too much stress to one of those structures, it incurs damage. Muscles and ligaments tear, and bones fracture.
A Jones fracture involves the fifth metatarsal—or the bone that connects the base of the little toe to the bones that make up the heel. Specifically, the break occurs in the proximal portion of the bone—or the part closest to the heel.
In football, an athlete may sustain a Jones fracture when a hit forces the front of the foot to suddenly and sharply turn inward while the toes are pointed downward.
Like all fractures, the amount of fracture displacement—or how much the broken pieces are misaligned—looms large when determining the proper treatment course. Additionally, the precise location of the fracture can also guide therapy, and in a Jones fracture, differences of mere millimeters can significantly alter management.
According to Dr. Adam Bitterman—an orthopedic surgery resident physician based in New York—it comes down to blood flow.
"A true Jones fracture occurs at the junction of the metaphysis and diaphysis (of the fifth metatarsal)," Bitterman explained. "Because this zone is a watershed area, meaning the vascular supply may be limited, it is prone to nonunion, and surgical treatment is indicated."
The term "diaphysis" describes the long, central part of a bone, and the "epiphysis" refers to the end of the bone. The "metaphysis" lies in between the two.
As Bitterman mentions, the point where the metaphysis meets the diaphysis does not carry a very robust blood supply—relative to other surrounding areas, at least. As a result, Jones fractures may not always heal well, as it's blood that transports the body's healing and repair cells to injury sites. In fact, in a significant number of cases, nonunion—where the broken bone does not heal back together—can occur.
That's where surgery comes in.
"Elite athletes choose surgery to limit the chances of nonunion by enhancing fracture fixation," Bitterman went on. "Surgical treatment is via intermedullary screw fixation. The athlete will remain non-weightbearing for approximately six to eight weeks."
In other words, by using a metal screw to secure one end of the broken bone to the other, a surgeon can fix the fractured metatarsal into place while it heals. The athlete must then avoid bearing weight on the foot, which could stress the healing bone and deter healing.
Bitterman added that in addition to minimizing the chance of a poor outcome, surgery sometimes allows earlier return to sport than nonoperative treatment. That said, he emphasized that even with surgery, radiographic images such as X-rays must demonstrate union of the broken bone before an athlete can safely return to play.
With that in mind, Tuitt and his medical team are surely proceeding with a conservative mindset. Fortunately, at this point, he is likely well on his way to recovery. Even better, no news of complications yet exists.
Nevertheless, as the draft inches closer, NFL medical staffs will certainly continue to pay very close attention to the former Fighting Irish lineman's medicals, and any sign of poor healing—or a setback in his rehab—will undoubtedly affect his medical grade.
After all, when a high draft pick rides in the balance—and possibly millions of dollars—a medical risk-versus-reward analysis may carry more weight than any other element of Tuitt's draft portfolio.
Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine. Quotes were obtained firsthand unless otherwise noted.
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