Why can’t we have nice things? Football season hasn’t even officially started yet, and already we have an injury to an ascending star in the NFL: Deebo Samuel. On Tuesday, Samuel fractured his left foot, putting the start to his 2020 season in jeopardy. Deebo’s left foot injury is referred to as Jones Fracture, and it can sometimes be a difficult injury to come back from. Below I will explain what a Jones Fracture is and how this could impact Deebo’s 2020 season.
What is a Jones Fracture?
The Jones Fracture is specific to the 5th metatarsal (toe bone) and is located at the proximal (base) of the bone closed to the heel.
The mechanism of injury for this type of fracture typically happens when a person’s foot is plantar flexed (toes pointed downward) and ankle is inverted (pointing in).
If you feel along the outside of your foot and run your fingers from your pinky toe back towards your heel, you can feel a bony protuberance on the outside of your foot. This is the base of your 5th metatarsal. As you probably noticed, this bony structure is prominent and there is not a lot of padding around this area of your foot. Because this area is exposed, the base of the 5th metatarsal can be easily fractured when you land on the outside of your foot. The prominence of this area is often why flare ups can occur post-injury and surgery, which I will address later on.
Jones Fracture Research in the NFL:
There have been a couple of studies published over recent years that track NFL player performance following a Jones Fracture.
[1] A study by Robert Spang, MD et. al examined a sample of 40 collegiate athletes between 2009 and 2015 who sustained a Jones Fracture and went on to play in the NFL. Although the data was not statistically significant, on average players with a previous Jones fracture performed worse within the first 2 years in the NFL compared to a healthy control group. The lack of statistical significance means there could have been other variables contributing to the dip in performance other than the Jones Fracture. Looking specifically at WRs (sample of 14) the study did show that WRs with a Jones Fracture played fewer snaps (snap percentage 17.5% ± 26.4%) compared to the control group (snap percentage 53.0 % ± 25.4%). This data was statistically significant (p-value = 0.03).
[2] Research by Selene G. Parekh, MD, MBA and, Jay Shah found that when NFL players tried to come back from their Jones Fracture too soon (prior to 10 weeks) the risk of re-injury was much higher than those who returned to play later than 10 weeks. Additionally, those NFL players who resumed play prior to 10 weeks saw a decrease in overall performance. Specifically, re-injury rate was 20% with a 53.2% performance reduction for the early return to play group, compared to only a 9% re-injury rate and 9.4% performance reduction in the >10 week group. Although the sample size was small, the research here suggests that NFL players should wait at minimum 10 weeks prior to resuming football activities.
[3] Finally, research published from Craig R. Lareau, MD, Andrew R. Hsu, MD and Robert B. Anderson, MD (the surgeon who performed the surgery on Deebo Samuel’s left foot) demonstrated quicker recovery times (average of 8.7 weeks) for NFL players, however the WRs tested had a longer return to play timeline of ~11 weeks. Re-fracture rates were low at 12%.
So What Does This Mean for Deebo?
Based on the research that I highlighted above, I feel it’s fair to project 10 weeks for Deebo’s return to football activities. Although it is promising that the surgeon (Robert Anderson) performing Samuel’s surgery published work showing return to play in under 9 weeks, other research has suggested it is optimal to wait slightly longer. This would also align with the timelines being suggested on NFL Network and Twitter.
For Deebo Samuel, 10 weeks post surgery would be August 27th. San Francisco’s first regular season (assuming it starts on time) is September 13th, roughly 2.5 weeks after Deebo would theoretically be cleared to return. The reports that emerge the next 6 weeks are going to be very telling if Deebo Samuel will start 2020 on the PUP. If Deebo has not resumed running by week 7 or 8 (July 30th-August 8th) then I believe there is a good chance he will start the season on the reserve PUP and miss the first 6 weeks of the season. Given the circumstances with Deebo being a young/promising prospect, the 49ers are going to want to minimize the risk of re-injury. I think there is a decent chance San Fran holds him back and puts him on the reserve PUP.
Based on my clinical experience rehabbing Jones Fractures, there is a chance that fantasy managers with Deebo on their team are going to be frustrated. The surgery for Jones Fracture involves using hardware to stabilize the fracture site via a screw. With a screw in Deebo’s foot, there is a chance he experiences irritation/inflammation during the season. There is a chance he pops up on a lot of injury reports and is listed as a game-time decision multiple weeks. The 49ers may also limit Samuel’s snap % for the first half of the season. Limiting his workload would match up with the study I cited above, “Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance” [1].
Manage expectations with Deebo in 2020, because there could be a lot of peaks and valleys due to the uncertainty surrounding a Jones Fracture. The 6-8 week mark could be very telling for how the 2020 season is going to go. Hopefully by then you will have some clarity in time for your 2020 fantasy football draft.
References:
[1] Spang, R. C., Haber, D. B., Beaulieu-Jones, B., Stupay, K., Sanchez, G., Whalen, J. M., Provencher, M. T. (2018). Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance. Orthopaedic Journal of Sports Medicine, 6(7_suppl4). doi:10.1177/2325967118s00129
[2] Parekh, S., & Shah, J. (2017). Optimal time to return to play and performance after Jones fracture surgery in the National Football League (NFL) players. Foot and Ankle Surgery, 23, 34. doi:10.1016/j.fas.2017.07.186
[3] 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, 37(1), 8-16. doi:10.1177/1071100715603983
