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The Doctor Is In: Antonio Brown Toe Injury Inspires Sunday Speculation

As anyone following the Pittsburgh Steelers, or lucky enough to have Antonio Brown in a Fantasy Football lineup knows, the star wide receiver missed practice Friday and Saturday with what was called a toe injury.  It is not clear if Brown sustained the injury in the Sunday game against the Green Bay Packers or if this is a new injury which occurred at practice during the week.  Even more unclear is whether Brown will be on the field when the Steelers take on the Bengals on Monday Night Football.

According to Ray Fittipaldo, it isn’t looking very promising.

On the flip side, Ian Rapoport is more optimistic.

The bottom line is that we don’t know what the injury is, how serious it is, or whether AB can play through it.  But since the Steelers aren’t playing today and we all have free time, let’s look at different toe injuries that NFL players typically get.  And as always, let’s start with the basic anatomy:

The metatarsal bones form the forefoot, and the phalanges are the skeleton of the toes.  The bones are all held together with ligaments, usually named for the bones they connect.

TURF TOE

Figure 1 (www.thetoedoctor.com)

Turf toe refers to a sprain of the metatarsophalangeal (MTP) joint, the connection between the big toe bone and the forefoot.  This is one of the more common injuries, often seen in running backs and wide receivers, who change direction rapidly.  The injury occurs when the joint is hyperextended, with the heel in the air and the toe jammed against the ground.  Obviously, this can occur on any surface, not just artificial turf.  Like most sprains, this one is described by grade (1-3), depending on severity.  Here is a summary from the American Academy of Orthopaedic Surgeons:

  • Grade 1. The plantar complex has been stretched causing pin-point tenderness and slight swelling.
  • Grade 2. A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
  • Grade 3. The plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.

Surgery is usually not necessary.  Ice, NSAIDs, and rest is the typical treatment.  Often the toe is “buddy taped” to the next toe to immobilize it.  More serious sprains require a walking boot.

Recovery is fairly quick for milder sprains, and often an NFL player will not miss any playing time.  Depending on the player’s position and how limiting it would be, a stiff-soled shoe or a plate insert can be used.

TOE FRACTURE

A broken bone can be the result of a single injury or repetitive activity, also called a stress fracture.  Fractures can be displaced, where the bone is no longer aligned, or non-displaced.  The most common symptoms are bruising near the joint and pain with walking.  An xray usually makes the diagnosis.  Here’s the typical bruising pattern (and I did yell just a bit when I did it):

There are 2 phalanges in each toe.  The longer one, which is more proximal, is more likely to fracture.  This may result from a direct injury like dropping something on your foot or ramming your foot into furniture (we all know that moment of son-of-a-gun blinding pain, which fortunately passes pretty quickly).  Jamming the toe against the front of a hard shoe like a cleat can also cause the bone to break.

“Buddy taping” is helpful with this type of injury as well.  Supportive care is the normal treatment.

Other ligament injuries involving the toes are fairly uncommon.  Ligament injuries involving the metatarsals are much more complicated, but those are typically referred to as “foot” or forefoot” injuries, like the dreaded Lisfranc injury.

Disclaimer: everything that follows from this point on is pure speculation as it relates to Antonio Brown.

So apparently AB posted a photo of his foot on Instragram yesterday, which has subsequently been deleted, most likely at the team’s request.  The Steelers do love their secrecy when it comes to injuries, after all, and they don’t like their players discussing injuries or providing any information about them.  Here is the photo, as well as a photo from 2014 taken during an acupuncture session:

The IG photo is pretty blurry, so the only thing I can say for sure is that there really isn’t any significant soft tissue swelling – a good sign.  It seems that there could be some bruising on the proximal portion of his second toe.  Could Brown have a fracture of his second phalanx?  Maybe.  Really hard to tell.

Head Coach Mike Tomlin is traditionally very strict about sitting players who have practiced in at least limited fashion prior to the game.  The team will be traveling to Cincinnati today, so AB will not practice prior to the Monday night divisional clash with the Bengals.  If there were ever a time to make an exception to that rule – short of a win-or-go-home playoff scenario – this would be it.  The Steelers play the Bengals twice each season and the know that team well.  In addition, Ben and AB make up there plays as they go half the time anyway.  And Brown at half-strength is still better than most WRs in the league.

I’m not lucky enough to have Antonio Brown on any of my fantasy teams, but if I did, I would definitely leave him in my line-up.  I’ve been wrong before, but my guess is that he suits up Monday night

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