NFL Draft Foot Injury: Abdul Carter's Stress Fracture Analysis

What's up A to Z Sports Nashville Titans beat writer reporter Easton Freeze here with a very

very special edition of Doc Talk thanks to our friends over at the Bonin Joint Institute of

Tennessee joined today by Dr. Jeff Watson special specializing in foot and ankle orthopedic surgery

Jeff thank you so much for joining us today man. Easton thanks for having me glad to be here

So we're talking today about Abdul Carter who's one of the top picks in this year's draft is going

to be a top five selection but it was at the combine last week in Indianapolis where it was

revealed, if folks missed the news, that testing showed he had a stress reaction in his right foot

The Penn State wideout was going to need to decide whether or not to have surgery. Ultimately, it came out after this post from Adam Schefter that he would opt not to have the surgery

And so he will be participating at Penn State's Pro Day later this month

But a stress reaction, I think a lot of folks saw that and thought stress fracture

No, a stress reaction for the top draft pick. And we wanted to get your expert insight on this because I think most people see stress reaction and have no idea what that is

I have stress reactions sometimes to things that happen in my life. Yeah, right

We have plenty of stress reactions watching the Titans. Exactly. Physiologically in the foot

What is a stress reaction? Is it different from a stress fracture? Well, you know, it's kind of like a spectrum, right

So a stress reaction is like a precursor. It's kind of what happens right before a stress fracture

So a stress fracture being an overuse injury, you kind of overload the bone

At first, it would be something that would never show up on x-ray. It would be something you'd see on an MRI, and the bone would have swelling within the

bone itself. And that's what a stress reaction is. And so once you get to the point where it loads enough to create a crack, then you call

it a fracture. And so usually stress reactions are a bit easier to get over comparatively

How does it happen? How do you get a stress reaction? And secondly, how do you realize you have one besides just happening to have an MRI

Is there a way that you can tell? Well, pain is usually the generator, and often swelling will happen with that as well

You know, the navicular was the bone Abdul-Carter has an issue with

You know, that can be a very subtle thing, and even a fracture in that area will often

need an MRI to visualize it. So it's pretty common to get those. And some stress fractures are not a big deal

There's some in the front of the foot, the bones called the metatarsals

Those usually heal on their own. But ones in the navicular or the outside metatarsal the fifth metatarsal like Derrick Henry those stress fractures those can be much harder to heal and require surgery And that has to do with blood supply Both of them have issues with blood supply where they get blood from both sides and they kind of get this watershed area where it not as good in that area So that why we typically have to do surgery to give it a better chance to heal

So that's the touch point that I think most Titans fans go back to is that Derrick Henry

Jones fracture. And you correct me if I'm wrong, but that it's that fifth metatarsal, right

That is a fracture. And so you're saying it's a similar area of the foot, but a different bone

a different bone, similar issue. I'd say that they have like a blood supply. The fifth metatorsal

has kind of blood coming from the top down and the bottom up. And then the vicular has it coming

from kind of the inside of the foot and the outside of the foot. And that kind of middle third of the bone doesn't have a great blood supply. And that's generally where the fracture

happens. And so, you know, one, one issue is blood supply, which is not something you can

necessarily change. But we often see with stress fractures, low vitamin D can be a factor. So

you know, if you've got low vitamin D, that means your body has a harder time absorbing calcium

which usually helps to build strong bones. And so that may be a factor too. If, you know

your diet's not what it should be, you know, that could be another role in creating that

And then, I mean, you've got these guys who are, I mean, Carter is an absolute like physical

specimen, right? He's probably loading his bones much more than I would be. And so, so if he is

doing that kind of quality of activity, there is always a chance you could develop a stress fracture

with that. So will a stress reaction go away? What's the, you know, as I mentioned, there was

a debate whether or not he'd get a surgery, chose not to ultimately. Is that an indication that

there's hope it heals on its own? Does that require rest? What's the treatment? Yeah, typically rest

a walking boot. You know, if it gets to the point of a stress fracture of the navicular

it's a much different story. That's usually surgery and an athlete, and then non-surgically

can be treated and non-athletes by just not putting weight on it. But typically that's for

six weeks for most. So a stress reaction, it's just basically kind of like a bruised bone

And if you just kind of shut down your activities, you don't typically have to be

off of your foot, you can still walk on it. And it will typically calm down in about a month

So, of course, you don't know his specific case, but what generally is the argument

for choosing to or not to get that surgery? Yeah, I mean, the biggest risk there is just

future injury. And I think that that's kind of a great debate. If you've had one stress reaction

I mean you were sort of creeping up on the potential for that to happen And stress fractures can be pretty debilitating Patrick Willis you know he had a navicular stress fracture Joel Embiid had a pretty difficult stress fracture and ended up requiring a couple surgeries And so

there are, you know, those are instances where, you know, it can take you out for a period of time

So if you're a team kind of looking at this guy like, am I going to take him? Well, he's probably

got a little bit higher potential that he may have a period of time out for another stress fracture

in the future. If you've had one, that's a big risk factor for getting another one. So even if you get the surgery after having had one, you're still at risk

Oh, sorry. The surgery would decrease your chance of that. Gotcha. So it's the fact that he chose not to, which is the concern there

Yeah. And that would be, I would say, a little aggressive to do surgery in that setting

But, you know, in some of these athletes, I mean, that there's a lot of money on the line

and missing games matters. So you might choose to be a little bit more aggressive in those

situations. Is that something where it would be a, it would be an instant where he realized

that you step on it wrong. It's like, Oh, there it goes. Or is that something that you have to

constantly monitor when you're aware of, Hey, this high level athlete, he's got this stress

reaction. He may not ever realize that he turned into a fracture or not. We're going to have to

keep checking on it. Yeah. I think it will be mainly driven upon pain. And man, my experience

with those guys is they don't feel pain like most of us do right so it becomes kind of hard to tell

and so you know if he just becomes at a point where he's not functioning like you should i think

they'll start looking more into it and potentially get another mri or additional imaging like a ct

scan to look at it you mentioned those those other guys in sports that we all know and know

for having had missed so much time because i mean joe mb it's this terrifying name when you're

talking about a guy who has a potentially a similar ailment and it's going to be a, you know

somebody that a franchise tries to stake their future on. Um, I don't know. Can you, can you

make it make more sense for him to choose not to, you know, you said, I guess you just said that it

would be, it would be aggressive to do it now, but if the concern is, you know, Hey, it's just a six

weeks for six week recovery for, for this surgery, that would be a little preemptive. Why not go

ahead and have the surgery. Yeah, I guess the risk on the other side, I mean, it may be one that

you know, if he knew that he had like a vitamin D deficiency, and that was maybe a primary factor

for it, I mean, you could potentially take more vitamin D, get that back up to where it should be

and then that would decrease your risk of it coming back. And so not knowing his full

sort of history of it it can very well be one where he doesn you know necessarily have to have surgery You know if you don have a fracture I mean it pretty uncommon to do surgery for that So that is a bit even more aggressive than most people would do

Is having a stress reaction indicative of something? So say you have a stress reaction

you take two or three weeks, you maybe even get a scan on it to make sure, hey, this is gone now, we're in good shape

Is that something that, hey, this is a weak point in my body physiologically

where I'm going to have to – there's a chance that this happens again. This is where I'm at risk for this going forward

Yeah, some of that can be taken care of with, like, mechanical things too

like an insert in your shoe may help to transition the way the forces are loaded

through the foot. And in the NFL, they're making, like, custom cleats with inserts, you know

So I think that, you know, I see – you know, I don't know that that's as prevalent

in the college game. So that may be something where, you know, custom orthotics may help to decrease

that incidence too in addition to vitamin D. So he's got some potential ways of sort of managing that

and potentially decreasing the chance of that happening again. Last question for you

That's generally all short to medium term, thinking about a guy that's going to be drafted

and have a big rookie year long term. Thinking back to those guys like Joel Embiid

who's been dealing with that issue on and off and on and off for years now

having chosen not to get the surgery, risking a potential fracture in the near future. How do you keep that from being a long-term

inhibitor of career success? Yeah, I think, you know, managing that based on, you know

orthotics, like we talked about, vitamin D. And then if you do start having symptoms

kind of knowing about it early on to kind of adjust what you're doing, you know, decrease

the load you're lifting and go more towards like an exercise bike elliptical, decrease the load on

the foot and that that would generally kind of just give it a little window to calm down and and that would get better within a couple weeks whereas a stress fracture I mean that's going to

take like months to get where you want to be awesome thank you so much great insight I feel

like I know a lot more about this situation than I than I did before and hopefully our audience does

as well so that's the skinny guys on the the top of the draft there with Abdul Carter something that

I think teams are going to have to think long and hard about because that sounds like something that

is not nothing when it comes to you know a top pick in the draft jeff thank you so much guys

check out the bone and joint institute of tennessee they're fantastic they'll help you with

all of your bone joint orthopedic orthotic needs that you have they're right off the interstate

here in williamson county fantastic facility fantastic people like dr jeff watson thank you

for your time my friend thanks hasten happy to be here thank you