Dez Bryant Foot Injury Update
So the first weekend of the 2015 NFL season is behind us and for some unfortunate players, teams (and fans), the injury report is quite lengthy and includes some notable football players whose teams will be scrambling to fill the holes left in their absence.
One of the more prominent injured players was Dallas Cowboys wide receiver Dez Bryant, who left the Cowboys-Giants game in the second half with an injury to his right foot. X-rays after the game revealed that Bryant has suffered a fracture to the 5th metatarsal of the right foot. the Dallas Cowboys wide receiver underwent surgery of the right foot on Tuesday to have a metal screw placed to stabilize the fracture.
Types of Fifth Metatarsal fractures
There are three main types of 5th metatarsal fractures:
Avulsion fractures tend to be a common injury in ankle sprains where there is an inversion of the ankle. As a result of ankle inversion, the perennial brevis muscle, which attaches to the base of the fifth metatarsal, can cause a small avulsion at the base of the metatarsal.
Types and locations of 5th metatarsal fractures. From physio-pedia.com
These avulsion fractures of the 5th metatarsal tend to be treated conservatively (non-operative) if there is no (or little) displacement of the fracture. Typical this type of fracture is treated with either casting, walking boot or cast shoe, depending on the compliance of the patient.
If there is a significant amount of displacement of the fracture, in some cases, surgery may be indicated to prevent potential non-union of the fracture fragment.
Usual healing time for 5th metatarsal avulsion fractures are usually 4 to 6 weeks in the non-displaced fracture.
A “Jones” fracture is a fracture through the meta-diaphysis junction near the base of the fifth metatarsal.
Jones fractures tend to be more difficult to treat and often require surgery, especially in athletes. Due to the anatomy of the blood supply to the fifth metatarsal, Jones fractures have a high rate of non-union. Many foot surgeons will therefore opt to surgically correct this fracture as the initial treatment because of the risk of non-union and need for prolonged immoblization of the foot.
In case you were wondering about the origin of the name Jones fracture, it was named by Sir Robert Jones, a British orthopedist who suffered the injury himself while dancing and was the first to report a series of similar case studies in the 1902 Annuals of Surgery.
Spiral or oblique fractures
An oblique or spiral fracture of the fifth metatarsal involves the shaft of the metatarsal and typically has some angulation of the fracture associated with it. These fifth metatarsal spiral or oblique fractures also tend to be treated surgically in athletes to correct the displacement of angulation of the bone.
Spiral or oblique fracture of the 5th metatarsal – Credit – Naaike Verhaeghe/physio-pedia.com – CC
Can Dez Bryant come back in 4 to 6 weeks as some are saying?
He’s obviously a key offensive weapon for the Dallas Cowboys, especially after the Philadelphia Eagles signed former Coboys running back Demarco Murray. Bryant is also an important emotional leader for the Cowboys as well as seen in this video of him limping as he congratulates team mates last Sunday after they win over the New York Giants.
It will be difficult for two reasons:
1) Bone healing.
We haven’t found any specific reports on the type of fracture that Dez Bryant suffered, but in the best case, Dez has an avulsion fracture at the base of the 5th metatarsal. Typical, this fracture can heal in 4 to 6 weeks, but there may be a longer return to play since he underwent surgery instead. Jones fractures and spiral or oblique fractures with surgical correction usually take longer for athletes to return to full activity – more along the lines of 10 to 12 weeks in best case and even then, there is still a risk of refracture or hardware failure if he returns to football too quickly.
Even in the best case scenario of a 6-week return to play time-table, maintaining conditioning and physical fitness will also be a challenge as Dez Bryant’s foot heals. While Bryant obviously has access to world-class facilities for his rehabilitation, part of the challenge that the Dallas Cowboys sports medicine and training staff will face is making sure that he doesn’t try to do too much too soon on the foot and potentially delay healing of the fracture.