Breaking NewsThe defending Super Bowl champion New York Giants have had a tumultuous first two days of OTAs (Organized Team Activities). First they lost cornerback Brian Witherspoon, who reportedly suffered a repeat ACL tear. Yesterday wide receiver Hakeem Nicks fractured the fifth metatarsal in his right foot.

Nicks, arguably their most physically gifted catcher who hauled in over 75 receptions and racked up close to 1200 yards last season, suffered the injury while running a route during individual drills. “All of a sudden, he started limping,” head coach Tom Coughlin described in an interview on the NFL Network. “I thought he rolled his ankle over; well, it wasn’t his ankle.”

The fifth metatarsal is the long bone on the outside of the foot, at the base of the fifth or little toe. In the majority of people, fractures of this bone do not require surgery. The injuries usually occur at the base of the bone or in the midshaft, where the bones often heal uneventfully.

In high-level athletes, fifth metatarsal fractures often occur in a location toward the base of the bone where the blood supply and stress on that area make the possibly of not healing higher in these athletes. Therefore in most college and pro athletes with these fractures, orthopaedic surgeons often treat these injuries surgically soon after they occur.

Jones fracture postoperative x-ray
The surgeon has inserted a screw down the center of the fifth metatarsal in this professional athlete.
Typically the surgeon inserts a screw down the center of the bone under fluoroscopic x-ray guidance to compress the fracture together. This compression decreases the chance of the bone not healing and also potentially allows weightbearing early in the recovery process. Follow-up x-rays at regular intervals will show how the fracture is healing, and the surgeon will increase the activity he allows the athlete to perform. Once the bone has healed adequately, jogging and then sport-specific drills can be instituted prior to the player’s return to practice with the team.

Nicks is reportedly scheduled to undergo surgery today in Charlotte, North Carolina by Dr. Robert Anderson, who will insert a screw into the injured bone.
The Giants estimate that his surgery and subsequent rehabilitation process will sideline Nicks for up to 12 weeks.

Coughlin was fairly optimistic that his star receiver would return by the regular-season opener on September 5. “It’s probably going to be close,” the coach noted. “He feels very confident about it. The doctors have expressed it as being something that they think will heal very, very well.”

Fortunately for Nicks and other athletes who have suffered this injury, the operation has good success rates. Nonunions, even after surgery, have been reported. Insufficient screw diameter, which could lead to inadequate stability of the fixation, and overly aggressive rehab before the bone has sufficiently healed, could be possible causes.

Even though the 12-week timeline makes Nicks’ return for the regular season appear realistic, Giants fans will likely temper their expectations. Cornerback Prince Amukamara, the team’s first-round draft pick in 2011, broke his fifth metatarsal in training camp on Aug. 6. He did not play in a game until Nov. 20 but arguably never appeared to be completely healthy his entire rookie campaign.

Although last year’s breakout star, Victor Cruz, clearly had a better statistical year than Nicks, teams were reluctant to double-team Cruz in the slot. Nicks’ presence created a legitimate receiving threat on the outside. In his absence, the Giants will be pushed to get Reuben Randle, the Giants’ second round pick from LSU, up to speed with the first team offense as they look to remain competitive early in the season in the always unpredictable NFC East.

I want to thank Prateek Prasanna for his research and assistance with this post.