Last week, San Francisco 49ers’ player Patrick Willis announced he’s out for the season with a turf-toe injury. Many of you are probably wondering, what’s the big deal?
Well, actually, turf toe and Lisfranc fractures, a similar injury, are a big deal. Because athletes put so much pressure on the ball of their foot, when that joint wears out and there’s no stability, players can’t push off, sprint or change direction. And without these moves, they aren’t gonna play.
Last week, I had the chance to speak with WAKR morning show host Ray Horner about these injuries. They’re fairly common — and season, if not career, threatening. It ended the careers for the Steelers’ Jack Lambert and Pro Football Hall of Famer Deion Sanders.
Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on Nov. 12, 2014.
HORNER: Another thing I wanted to talk to you about this morning, Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital, in studio, yesterday in the NFL one of the all-pro players, Patrick Willis (of the San Francisco 49ers), announced he’s out for the season with a toe injury.
And a lot of people take a step back [and say], “What a pansy. I mean, he’s out for the year because of a toe injury?”
But, we’re seeing more and more, and he hurt this toe playing on field turf. Stretched the toe, the muscle, the tendons around that thing, and he said, “I just can’t go without my toe.”
DR. CONGENI: Yeah. This has been from the beginning of time …
Dr. Joe Congeni
HORNER: Do we see a lot of this, Joe?
DR. CONGENI: … this has gone on back since 1969 when the first generation of turf came out and that’s why it became known as turf toe. One of the toughest players of all time, you know I like the history of sport, a Steeler of all things …
HORNER: Jack Lambert.
DR. CONGENI: … Jack Lambert’s career was ended. How much tougher do you want to be than Jack Lambert?
Because you put so much pressure on the ball of your foot to push off and run and cut, when that joint wears out, the ligament that holds it in place, like the ACL of the great toe, when it tears and you have looseness, [you can’t go].
They try all kinds of inserts and taping and other things that work for a while, but when that [joint] starts to wear out and there’s no stability, people just cannot push off and sprint and cut and change direction with turf toe.
Turf toe is a big deal, and you will often see people whose season ends — and even in the old days, career ends. Although again, with the newer technology and newer techniques, we’re getting better with that. Most people’s careers [are] not over.
But, he’s gonna need surgery to have that stabilized because that ligament is so torn, it’s so worn out and you start getting arthritis in the toe, you cannot play with it.
HORNER: What do you do on that surgery? Do you just go in and tighten things up or do you put a new one in? How’s that work?
DR. CONGENI: Well, there’s all, all of the above.
HORNER: All of the above. [laughter]
DR. CONGENI: There is some work on a new joint, just like, oh my gosh, joint replacement. There are some people that have just significantly worn out [joints] where you just put a pin in it and forget about having a joint there at all … or there are some people where you actually tighten it up. So, it can be any of those things.
I will caution you of one thing. I know also A.J. Green (of the Cincinnati Bengals), everybody’s saying, oh my gosh, his is a foot or toe injury, but then I’ve seen him say, well, it’s not turf toe.
There is another injury that occurs a little bit further down the foot called, you hear this a lot, the Lisfranc fracture.
HORNER: Yes.
DR. CONGENI: The Lisfranc foot is actually also a ligament injury. There’s no stability in the front of the foot, we call it the forefoot, and people cannot push off. But, it’s not in the great toe. It’s the next joint down, between the first two, um, metatarsals.
What happens is they get a ligament injury and they cannot play with this in the NFL either, with the Lisfranc foot. It’s a fairly common injury … and both of those injuries — turf toe, Lisfranc — can cost an NFL player, a high-level pro athlete, to be out for an entire year having surgery.
HORNER: I think it ended the career too, correct me if I’m wrong, Deion Sanders. Didn’t he have turf toe that ended his career?
DR. CONGENI: Yes.
HORNER: But, you’re saying now with advancements it’s not so much career threatening, but year ending … in most cases?
DR. CONGENI: Yeah, but there can be some cases where people try to play with it and they wear that joint out so badly that it could be career threatening, too. But, at the very least, you’re whole premise of this whole thing is, c’mon, it’s a toe, but if you can’t push off and you can’t run, [you can’t play].
The NFL is all about milliseconds between getting to the ball carrier, getting to the quarterback, getting away from somebody else, and when you don’t have it, the ability to push off, you’re not gonna play.
HORNER: Well, and mine is so minor, when I get gout in my big toe, I can’t even chase the ball around the front yard with Rocco.
I can only imagine, when you don’t have that toe, you don’t understand it until you don’t have it and I got to realize that with gout, you can’t do much, let alone be an NFL linebacker or wide receiver. I can’t even catch the ball from my son.
DR. CONGENI: The size of that joint is about the size of a marble, so it doesn’t seem very big. But your entire body weight [is on it].
And, as these people get bigger and bigger, it’s part of why these injuries occur more — 280 pounds, 315 pounds on that little joint that’s the size of a marble, pushing off on a hard surface like turf every week. So, no wonder there’s more turf toe and Lisfranc.
HORNER: Alright, Joe, great stuff. Thanks for coming in this morning.
DR. CONGENI: Okay, Ray. Thanks a lot. It was fun.
HORNER: Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital.
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