The Minnesota Timberwolves had a pretty healthy 2016-17 season all things considered. Nikola Pekovic missed the entire season due to recurring ankle pain and Zach LaVine tore his ACL on a freak play in early February, but perhaps the most under-discussed (and now the most important since Pekovic retired and LaVine was traded) injury is Nemanja Bjelica’s navicular fracture.
The navicular is a small bone on the inside of the foot and is a key member of a group of bones known as the tarsals. The navicular plays an important role in maintaining the arch of the foot as well as helping the foot transition from being flexible at heel strike to more rigid during push-off during walking, amongst other things. Due to its location, importance and involvement during movement of the foot, as well as its tenuous blood supply, the navicular is the most frequently injured tarsal bone, though, overall, navicular injuries are pretty rare.
Bjelica had surgery to repair his fractured navicular bone in his left foot on March 21, 2017, after injuring it in a loss to the Boston Celtics on March 15th. There are three types of navicular fractures – avulsion, tuberosity, and body – and all three can either occur from acute (read: sudden) or chronic (read: stress fracture) trauma; it isn’t abundantly clear which of these Bjelica suffered as it was only reported that he had a fracture. All three are caused by stresses placed on the navicular directly and through structures that attach at specific sites on the bone, the details of which are beyond the scope of this article.
However, most navicular fractures occur in part because of an excessive axial force placed on the foot (think of a force running straight through the bone). As can be seen in the image below, Bjelica appears to injure his foot either has his left foot plants in preparation for a jump or right as he is about to take off; either motion would’ve no doubt place a significant axial force on his navicular bone.
Surgical repair of a navicular fracture typical includes placing a screw into the bone to provide stability with other screws and/or plates placed as needed as determined by the surgeon. The player is then placed in a non-weight-bearing cast or boot for 6-8 weeks with a gradual return to basketball activities and eventually play after approximately 6 weeks of physical therapy to regain proper mobility in the foot. Overall, it generally takes players 3-4 months to go from the onset of the fracture to the player being back on the court. However, this timeline can be extended if nonunion (the bone is slow to heal) or osteonecrosis (the bone tissue dies) occurs.
Although we haven’t heard many updates on Bjelica’s status, I would imagine that he would be ready to go by the time the Wolves take the court for their first preseason game on September 30, barring any setbacks. Going into the future, it will be interesting to monitor if/when Bjelica suffers from further foot pain as it is pretty common for people to deal with persistent stiffness and pain after the initial break.
Bjelica figures to be an important piece for the Wolves in the upcoming season due to the team’s current lack of depth. If he returns healthy and is able to play as well as he was just prior to his injury (9.9 ppg, 7.3 rpg, 2.1 asp in the nine games before he went down for the season), he’ll undoubtedly provide much some needed impact for the Wolves’ bench.
Another foot injury currently plaguing the Wolves is rookie Justin Patton’s fifth metatarsal fracture. The fifth metatarsal is on the outside of the foot and serves as the base for the pinky toe and is the most commonly fractured of the metatarsals (for further clarity, the 5th metatarsal is on the opposite side of the foot as the navicular bone). The 5th metatarsal is most frequently injured in three sites, as seen below:
What makes discussing Patton’s injury particularly difficult is that it isn’t currently known how the injury occurred as well as the specific fracture site; all that is known is that Patton fractured his 5th metatarsal during a workout and underwent successful surgical repair on July 4, 2017.
Avulsion fractures typically occur when the foot is forcefully inverted while it is plantarflexed (in English: basically what happens when you “roll” your ankle). These fractures are caused by the pull of the fibularis muscles (the muscles that attach to the fibula while their tendons attach at zone I seen above) that contract in attempt to pull the foot back into eversion (the opposite motion of inversion) as a protective mechanism; this forceful contraction literally rips a chunk of bone away.
The typical treatment for 5th metatarsal avulsion fractures includes placing the player in a walking boot for 6-8 weeks and allowing them to place weight on their foot as they can tolerate. Surgery isn’t typically indicated for the general population, though that doesn’t mean it isn’t possible/available for professional athletes. After the boot is removed, the player is gradually reintroduced to basketball activities.
The notorious Jones’ fracture has a similar mechanism of injury and surgery is more frequently performed to repair these injuries, especially in athletes. A screw is placed right through the middle of the bone to provide stability and the player is placed in a cast or walking boot for 6-8 weeks. The issue with Jones’ fractures is that the blood supply to zone II (as seen above) is far less than that of zone I or III; this presents the potential for nonunion to occur, which would elongate the player’s timeline for return to play. If all things heal according to plan, the player usually returns to games roughly 3-4 months post-injury. This would put Patton returning to action come October or early November.
Regardless of his injury, Patton was likely to see most of his time with the Iowa Wolves this season, so there is no sense in rushing him back from injury. Hopefully, he is able to return sooner rather than later, but foot injuries can sometimes linger, so it only makes sense to hold Patton out until he is completely healed and ready to play. His health is more important for seasons to come, not for the 2017-18 campaign.