Clemson fans frustrated by the Tigers’ lackluster offense were surely discouraged to see Andre Ellington injured in the team’s loss last week at Boston College. The sophomore running back and former Berkeley High School superstar was diagnosed with a toe injury. As Travis Sawchik reported Friday, Ellington is expected to miss two games, which should keep him out through Saturday’s game against Florida State. I am not involved in Ellington’s care, but I’ll try to explain what turf toe is and why a toe injury can be so debilitating.

To understand what likely happened to Ellington, stand up with your left leg in front of you and your right leg behind you, as if you were running. Bend your right ankle down so that all the weight of the foot is on the ball of the foot and toes. Now imagine if another player landed on the back of your ankle while your foot is in this position. All of the force would be directed onto your first metatarsophalangeal joint, or what most people know as the ball of the foot. The force would cause that joint to hyperextend, injuring the capsule, ligaments, and other soft tissue structures beneath this joint.

This type of injury is nicknamed turf toe due to the high number of NFL players who have suffered it over the years, especially those who played on artificial turf. Both the synthetic playing surfaces and more flexible shoes that were worn in the past are thought to be contributing factors. Many of the shoes worn by athletes now are very flexible to allow more range of motion. Critics of these shoes claim that the increased agility comes at the expense of more frequent injuries.

Typically athletes who have injured their foot in the manner described above will have a tremendous amount of pain and swelling at this joint. It can be difficult to bear weight, but those who can do so often complain of difficulty pushing off or changing directions. Those of you watching the Boston College game might remember Ellington trying to test his foot on the sidelines to see if he could push off. Although it’s a soft tissue injury, doctors usually order x-rays. X-rays might show displacement of the sesamoids, which are smaller bones underneath this joint, which could signify a more serious injury. An MRI is occasionally used to more fully evaluate the integrity of the capsule and ligaments. An MRI might have been performed in this case, as it has been reported that Ellington also has a torn ligament.

Ellington reportedly saw a foot specialist in Greenville. According to a Clemson spokesman, Ellington will miss at least two weeks, but the team is not guaranteeing that he will return this season. Presumably if he is only out two weeks, this is a mild form of turf toe. More serious forms of this injury often cause players to miss entire seasons, and occasionally surgery is performed on high-level athletes if the joint is unstable or there is complete disruption of the soft tissue structures. Ellington has been seen walking in a boot, which doctors use to try to get the capsule and ligaments to heal.

When Clemson doctors and training staff feel that he has healed, as evidenced by his pain decreasing and motion at that joint increasing, they will let him try to use it. Likely they will try to protect the joint, either by taping it or putting a rigid insert into his cleat. That does lead to a dilemma though, as limiting motion at that joint can also potentially limit his ability to push off and cut as effectively.

If Ellington does return in two weeks, or at some point this season, it will be interesting to see if his turf toe allows him to make the electrifying moves that Clemson fans have become accustomed to seeing.

Note: The following article appears in tomorrow’s edition of the Post and Courier.