New England Patriot’s Quarterback Tom Brady Has Foot Surgery
Patriot fans were devastated with last week’s loss to the Jets. But, there is now concern over the foot of star quarterback Tom Brady, who underwent surgery on his foot for a stress fracture. What is so worrisome about this injury and what is the navicular bone?
The navicular bone of the foot lives in the inner middle part of the foot. It is an exceptional bone in that it does not have a great blood supply. This bone interacts with four to five other bone of the foot, which leaves little room for blood vessels to enter the bone. Furthermore, two major tendons attach to this bone, using the bone as a lever arm to move the foot. Through these tendons, the navicular plays an important role in maintaining the arch of the foot.
The blood supply to this bone is not great. There is an area of relatively low blood supply, making it difficult for this bone to heal.
The navicular bone can have a variety of different breaks or fractures: a cortical avulsion fracture (small sliver of bone breaks off of the navicular), a tuberosity fracture (a break of the attachment site of one of the major tendons), a body fracture through the navicular, and a stress fracture (the most common injury to this bone). Brady’s injury, from reports, appears to be a stress fracture. A stress fracture is where the inner part of the bone breaks, but the outer shell is okay. If this is not treated, the outer shell can break. Given the poor blood supply, the bone has a difficult time to heal.
Patients who suffer from this injury can have dull aches and pains in the foot. There can be pain with impact activities, such as running or jumping. Some may be unable to put weight on the injured foot. There may be black and blue marks that develop as well. These breaks can be difficult to see with an xray. Many times, an MRI or CT scan of the foot is needed.
WHEN TO SEEK MEDICAL CARE
After an injury to the foot, if one is unable to place weight on the foot, medical attention is advised.
In the setting of a stress fracture, there are two modes of treatment. A short leg non-weight bearing cast can be worn for 2-3 months. The bone can have a prolonged course to healing before athletic activities are started. This can be up to 6 months. Furthermore, additional medications may be needed to help with the healing.
In the athlete, the other option is to proceed directly to surgery. In this case, 1-2 screws are placed across the stress fracture. Athletes are placed in a cast or boot for 4-6 weeks. Athletic activities are not started for about 10-12 weeks.
The danger of this injury is a possibility of the stress fracture taking a long time to heal or not healing at all. This is a concern because the navicular bone has a poor blood supply.
The long-term concern with this injury, if it heals, is a return to normal activities.
RETURN TO ACTIVITIES
Most individuals with this injury can be out of competitive play for approximately 2 to 3 months. If the bone takes longer to heal than usual or does not heal at all, this time frame can be delayed.
All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.