Evaluating Beau Yap's Injury

Dr. T gives his opinion on Beau Yap's injury and the most likely prognosis.

It was reported earlier last week that defensive end Beau Yap suffered a fracture to his right foot, and was forced to undergo surgery to repair it. This is not a small thing. Yap, a junior, was projected to be a starter coming off a strong sophomore campaign (37 tackles, 10.5 for a loss and 3 sacks) so this hurts quite a bit. He's projected to miss the rest of Spring Practice (though according to Steven Tsai people within the program are hopeful that he'll have his cast removed in May and be ready for training camp in August.)

My role here at WSN is as a…medical consultant. I'm using a pseudonym to both protect my anonymity and to encourage you the reader, to focus on what's really important. The injury itself. In analyzing Beau's injury, let's start with the fact that there are twenty-six bones in each foot and that the foot is typically divided into thirds: the forefoot (19 bones), midfoot (5 bones), and the hindfoot (2 bones). In the forefoot, the metatarsals (that connect to the toes) are often injured by crushing or twisting injuries. The 5th metatarsal (bone that supports your littlest toe), is the most commonly fractured and is at risk for being displaced since some key muscles connect to it and can pull parts of it away if fractured. There are a few types of fractures that can occur, including a Jones fracture and pseudo-Jones fracture. The Jones fracture, a break across the base, is bad news, since it often reconnects poorly and surgery is needed (like what happened to Beau here). A pseudo-Jones fracture is when a small piece of bone gets torn off which may sound incredibly painful, but actually heal quite well without surgery.

In the midfoot, the place injured most often among young athletes, one can have stress fractures of the navicular bone. These often happen in runners. Fractures of the body of the navicular bone also occur with crush injuries. These will heal well, but, if displaced, have an increased likelihood of reoccurrence, so surgery is recommended.

Lisfranc injuries though (may also be considered a forefoot injury) are very worrisome. These involve the ligament connecting the 2nd metatarsal and medial cuneiform, and have an easily compromised blood supply. They are difficult to diagnose with regular x-rays and often CT or "Cat" scans are needed. Doctors suspect that this type of injury occurs most often when a football player gets his foot stepped on while he is bending it down. This can cause extreme pain whenever torsion is applied to the foot and can also develop into severe arthritis and chronic pain if not treated properly. In the short term, they can develop compartment syndrome, where the internal pressure has built up so much that it cuts off circulation. However, these injuries are typically in a boot for 12-18 weeks which substantially decrease the risk of something like that occurring (keep your boot on Beau!).

The hindfoot is the most infrequently injured but the talus (connects your shin to your heel) can be fractured if your foot is bent upward beyond normal. These are worrisome because the blood supply is not great and the bone can die. However, these specific injuries are rare.

We know that in the world of athletics, we probably tend to be more aggressive in our treatments than we would otherwise, including utilizing surgery as a recovery tool. Circling back around to Beau, it's likely that although his bone fractured, it's unlikely to be one of the more serious injuries we described above. He plays defensive end, a role that does not commonly put his foot into positions that would lend themselves to a Lisfranc injury. Stress fractures can occur, but are more frequently seen in long distance runners. We may never have all the details here, but based on what we know so far, it sounds like the injury is a fairly common one (and his prognosis for recovery is good.) Get well soon Beau!

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