I like to keep a close eye on the sports world via Twitter, as news seems to break and spread the fastest on this social platform. Recently, I clicked on a tweet about Otto Porter’s recovery from a bone bruise in his foot, and many of the replies want to know why a bone bruise is taking so long to heal. After all, when he was first diagnosed with the injury back in November, Porter was only expected to miss about two weeks. Now it’s mid-February, and the team is using vague but encouraging terms like “nearing” or “getting closer” in regard to when Porter may get back on the court.
Figuring out exactly how long an athlete may be out with an injury is typically tough to do given the details that are published on the internet. Unless an athlete provides medical details in a personal Instagram or Twitter post, a lot of the necessary medical information remains hidden from the public, as the physicians involved cannot comment due to HIPAA regulations.
Assessing Porter’s Injury
Porter’s injury is a great example of people trying to parse out a recovery timeline based on limited information. If you look back, the injury was originally called “a sprain“. It was then referred to as bone edema or a bone bruise. Now he is diagnosed with a complete fracture. There are a few different bones within the foot where we see this pattern of injury progression.
The most common region where we see bone edema following a sprain is the talus. Following a severe inversion like an ankle sprain in which the foot rolls underneath the body, the talus bone is smacked into the tibia bone. The talus is one of the hardest bones of the body, but during some higher energy sprains, the bone can get hit so hard it develops a fracture known as an osteochondral injury to the talar dome. This particular injury often initially manifests as a bruise and then progresses into a complete fracture. Typical areas include the anterior lateral talus and the posterior medial talus. They can take several weeks to months to recover. If ankle instability develops and persists following these injuries, it may never resolve without intervention.
The second and considerably less common bone to sustain this injury is navicular. Right in front of the talus and more central in the foot, the navicular takes a lot of pressure and tends to break at the junction of the lateral and mid-3rd. If there is bone edema on an MRI, the fracture will eventually be identified on a CAT scan. This particular fracture can take many months to heal and oftentimes requires bone grafting and screw fixation in surgery along with months of recovery.
What is less well recognized about this fracture is that it is related to hindfoot sprains involving the calcaneocuboid ligament. Instability that persists in the face of no ankle instability is in my experience coming from that ligament’s dysfunction.
Other issues that could be at play include:
- The cuboid bone can also experience similar overload edema during an ankle or hindfoot sprain. The cuboid bone is on the lateral side of the hindfoot and when basketball players land on the outside of the foot they can bruise that bone.
- The fifth metatarsal, the dreaded Jones fracture, can also come from sprains and which patients roll their foot and ankle. Sometimes the fracture is incomplete and shows up only as bruising and edema and later develops into a complete fracture. These often do much better with surgery as well.
While any of the 28 bones bone in the foot can become bruised, the above four are the most common – the talus, the navicular, the cuboid bone and the fifth metatarsal. Hopefully Porter can continue to progress in his rehab and return to the court soon after this weekend’s All-Star festivities.
It’s also worth noting the role diet and nutrient intake can help play in bone healing. As we’ve discussed on the blog in the past, both calcium and Vitamin D can help bones heal quicker and help prevent stress fractures. Regardless of whether you’re a professional athlete or an average Joe, calcium and Vitamin D can play a big role in your bone health, so make sure you’re getting your daily dose!