First of all, from an anatomy standpoint, what is the fourth metatarsal and how does that affect somebody’s ability to run and to walk and to get around?
Will Carroll: Let’s talk a little bit about what the fourth metatarsal is. If you look down at your fourth toe, the “little piggy that went home” I think that is. If you follow that up, there is a bone that goes between the toe and your ankle. The bone that makes up your foot, there are five of them, this is the forth, counting from the “medial” side, the big toe, on out.
This is going to sound odd, but of all the diagnoses they could have gotten back, the fourth metatarsal is the one they wanted to hear because that one takes the least amount of stress. Had it been the fifth, the one on the outside, you can imagine that a running back is going to take a lot of stress on that as he cuts and runs as that foot rolls over in his natural gait – especially on turf fields that would have been devastating and out, perhaps for the season, but most likely for six to eight weeks.
Had it been the third, that one takes on a lot more stress as well and he would have a hard time accelerating and getting that push. Of course, Shaun Alexander has that great acceleration and burst. So the fourth is the best diagnosis.
The other thing to recognize on this is that the MRI is picking up the healing, and not the actual fracture. It’s a matter of when it was actually broken. Whether it was week two or whether it happened earlier and just got worse in week-two. That healing is going to be the toughest thing to actually follow.
Doug: Based on your experience, how long would you estimate that he would be out?
Will: I talked to some people today. I talked to the top foot-expert in the country, Dr. Phillip Kwong from the Kerlan-Jobe (Clinic), and he said if it was the fourth metatarsal this type of fracture, which is called a “March Fracture”, would probably take between two and four weeks depending on when it was broken.
The question then becomes function.
The last thing the Seahawks or any team would want to do is to see just a re-fracture. They have to make sure this is both stable and at least fused if not fully-fused. This wasn’t a displaced fracture, it never moved directly out of line, so it should heal relatively quickly.
With some of the advanced techniques like electro-stimulation and prescription medication to be used to enhance the bone structure and to get more calcium into that area, it should be on the low-end of that, I would guess at four weeks he should be ready to go. I’m not sure if the prayer will help him any, but I would think at least two weeks.
Doug: Speaking of the “power-of-prayer”, as Shaun put it, why would he, so soon after the fracture, would feel so good and reportedly be jumping around at Seahawks HQ and say that he’s ready to play?
Will: Remember what we said was what they saw was healing and not the actual fracture. It’s very, very difficult to pick up these small, stress-fractures on X-Rays which is why they missed it on week two. The healing is the biggest question.
Did he break this earlier? Has it been healing all along? Is he at the two-week point? Is he at the three-week point? That’s the difficult thing to determine here and really it’s going to be his “return-to-function” that’s going to allow this – if he’s jumping around, if he’s running and if that bone is truly fused and stable that can happen at whatever point because we don’t know where to start the clock on this.
Doug: Assuming they take all the precautions and they don’t get him out on the field until everything’s fused and everything’s fine, is there a degenerative aspect to this? Is he more susceptible to this happening again?
Will: Once it’s fully fused, no, it shouldn’t be a problem. We have to remember, going back a couple of years, Shaun Alexander missed a game with a similar foot problem and was able to come back from it, so it’s not as if this has been recurring. I don’t think this should be a problem.
Obviously, bones heal. Everybody has probably had a broken bone at one time or another - once it heals up it’s the same and it’s good to go and it’s stable. Shaun Alexander is no different than you or me in that respect.
Doug: Except he can run a lot better than we can.
Will: He can run a lot better than we can.
Many thanks to Will Carroll for taking the time to give us his exclusive analysis, and to .NET’s own Scott Eklund for transcribing this interview.
ESPN.com fantasy and injury analyst Will Carroll has also written for Football Outsiders and Baseball Prospectus. His columns examine injuries from a medical perspective to figure out not just when a player will return but why and at what strength. Will is the author of two books, Saving The Pitcher and The Juice: The Real Story of Baseball's Drug Problems, and lives in Indianapolis.