*From everything that I have read, it is a suspected sesamoid injury*
So I’d like to start this off by prefacing that the details of the injuries surrounding Carson Wentz and Quenton Nelson have been vague. All we have been given is a rough timetable for a return to play and that they suffered the exact same injury and underwent the exact same procedure. At this time, there is not much else to report on the suspected injuries.
Sesamoids
The suspected injuries involve the sesamoid bones in the foot. Two sesamoid bones lie on the bottom of the joint where the metatarsal (long bone of the first toe) meets the phalange (toe). The joint is called the metatarsophalangeal or MTP joint.
The sesamoids lie within the tendon of the flexor hallucis brevis, or FHB. The FHB function aids in flexing the big toe (think of trying to pick something up with your toes). Flexion of the big toe is essential in the push-off stage of gait which helps propel us forward.
A sesamoid bone is a bone that is encompassed in a tendon (the patella is the largest sesamoid in the body.) The sesamoids provide a mechanical advantage to the FHB by creating an altered line of pull allowing for greater force production and aid in shock absorption at the 1st MTP.
The sesamoids are less stable in the groves of the 1st metatarsal as toe extension increases. This allows for greater stress to be put on these bones and predispose athletes to injury. Football players are in a constant state of this position from driving somewhat back/running.
The Injury
The most likely scenario is that both Wentz and Nelson suffered fractures or had chronic pain (sesamoiditis) to one or both of the sesamoids. As a result, Wentz and Nelson likely had their sesamoid bones removed. Outside of the healing timeframe, the main focus will be on an athlete’s ability to push off the injured foot.
Although Wentz and Nelson play very different positions, both use FCB to push off whether it is driving someone back in the trenches, stepping up in the pocket, or running. Both players will need to be able to weight bear and push off before a return to play (RTP) will be considered.
Timetable for Return to Play
The given timeframe is 5-12 weeks for RTP. Per the National Library of Medicine, athletes have an average return to athletic activity of 7.5 weeks. Unfortunately, the NFL season begins in 4 weeks. I do not suspect them to be ready, but hopefully, they can beat the odds.
* Editor’s Note: Reports out of Colts camp on 8/11/2021 suggest that Wentz and Nelson may both be ready to play Week 1 which would put them closer to a 5 week return timetable or possibly less.
A sesamoidectomy, the surgical removal of the sesamoids, typically has good outcomes. I do not suspect that this injury will have too much future effect on these key Colts players. Unfortunately, the Colts have their bye week in Week 14 and will not be able to use the time off to their advantage.
