Last month, New York Giants linebacker Jon Beason went down with a foot injury—specifically, a sesamoid bone fracture and a torn ligament in his foot. NFL Network's Kimberly Jones and New York Daily News' Ralph Vacchiano reported the extent of Beason's injury the day after it occurred.
Both Jones and Vacchiano cited sources who believed the linebacker would need surgery—or likely would, at least. However, Giants writer Michael Eisen later reported that foot and ankle specialist Dr. Robert Anderson—the same surgeon who performed quarterback Eli Manning's arthroscopic ankle surgery—recommended a conservative approach of rest and immobilization.
To make better sense of Beason's diagnosis—and prognosis—it helps to take a closer look at the underlying anatomy of the injury. After all, the last time anyone sang the "hip bone's connected to the leg bone" song, the sesamoid probably didn't come up.
Multiple sesamoid bones—a general term for a bone lying within a muscle tendon—exist in the body. Beason's case involves one in his foot—specifically, under the base of his big toe.
Big toe sesamoid fractures can occur when an athlete plants his foot sharply, causing the toe to bend too far upward. Beason himself described a similar mechanism of injury—also via Michael Eisen—one that probably led to the break:
I was just changing directions. I would say that 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 that allows me to come in and out of my breaks faster. I literally felt like I stepped in like a sprinkler head hole. I just felt it give right away, so the next step I knew I couldn’t put the foot down.
The sesamoids in the big toe can be quite important to an elite athlete, as they help him or her use the big toe to propel forward off the ground with more strength. Nevertheless, sesamoid injuries can cause extreme pain in the area, as Beason now knows. They may also limit an athlete's push-off capabilities.
At this point, Beason is about one month into his recovery. If the original rehab plan Eisen mentioned held true, Beason may already be out of his cast.
After the exam and a review of Beason’s MRI, X-Rays and CT scan, it was determined that Beason’s foot will be immobilized for six weeks (three weeks in a cast and three in a walking boot) as the first step in his rehabilitation.
Immobilization keeps the damaged tissue—in Beason's case, both bone and ligament—in one place while the injury heals on its own.
The body's ability to heal any fracture depends on the precise nature and location of the break as well as the presence—or lack thereof—of adequate blood flow to the area. In general, a fracture with excellent surrounding blood flow often repairs itself well and without issue, whereas the opposite scenario leads to a risk of nonunion—or the bone fragments reattaching poorly or not at all. Certain types of sesamoid fractures can be prone to nonunion.
As always, precise medical details about Beason's care are not available to the public. Regardless, it seems Dr. Anderson—a bona fide expert of experts when it comes to sesamoid and other foot injuries—deemed the fracture and ligament tear of appropriate natures and locations to proceed initially with a trial of nonoperative therapy. If all goes well, the linebacker's pain will continue to subside with time, and he will gradually be able return to his prior level of conditioning after the walking boot comes off.
However, if pain persists for an extended period of time—unfortunately a possibility even with the best doctors practicing the best medicine—further evaluation might become necessary to assess the quality of Beason's healing. Surgical intervention could follow in such a scenario—a bone grafting procedure to stimulate healing, for example—though such an outcome probably remains several steps down the road.
With that in mind, Giants fans should keep an eye out for reports of recurring pain or swelling once Beason sheds his walking boot. That said, for now, nothing yet hints at any complications for the Giants defensive standout, and he is in the hands of some of the best medical professionals out there.
Dr. Dave Siebert is a second-year resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.