Something terrible is afoot: A look at Russell Okung's sprain and his immediate future

Bob Donnan-USA TODAY Sports

Field Gulls' favorite Trauma RN looks at the nature of foot sprains, the prognosis for Russell Okung, and the possible treatments available.

Ah yes, foot sprains. So inscrutable, so esoteric; the Virginia Woolf of sports-related injuries.

Russell Okung busted his foot and, by proxy, our hopes and dreams. But how bad is his injury, and how long will he be unavailable? Allow me to throw off this Drunkard hat, and slip into my ass-masking Nursing garb, and I shall attempt to clarify this injury, look at potential treatments, and timelines.

Pete Carroll has said that Okung has a torn ligament in his foot. Word on the street is that it is his Plantar Plate, a structure located in the metatarsophalangeal (MTP) and interphalangeal joints of the foot. This is the same thing that Pierre Garcon sprained, although we are unsure which toe it is.

If you have ever "Jammed a toe", chances are that you have had Grade 1 Turf Toe.

This seems like a good place to stop, and explain the difference between a tear, a strain, and a sprain. A sprain is what occurs when a ligament is stretched beyond its own capacity (think of an overstretched rubber band) and often occurs in conjunction with a dislocation. A strain is this exact same action, but with a muscle/tendon. A tear is a layman's word for both of these things. Remember that a tendon is what attaches muscle to the bone, and a ligament is what attaches bones to bones.

I am unsure how deep to into the anatomy of the foot, and specifically the plantar plates. The plantar plate is a structure of fibrocartilage on the balls of your feet, that limits dorsiflexion (lifting your toes), and supports body weight. Instead of using my words, I am going to disobey my mom, and show you a picture:

121106-plantar-plate-sprains-tear_medium

via www.sdri.net

Turf-toe_medium

via www.joint-pain-solutions.com

Complications

The most common problems that stem from this injury, if surgery is not utilized or is not successful, are persistant joint pain and stiffness (obviously, this fully hampers one's ability to run), loss of strength acquired from "pushing off), traumatic bunion deformity, arthrofibrosis (excessive scar tissue), hallux rigidus (inability to move big toe, along with persistent pain).

With adequate compliance (and a little luck) all of these can be avoided, and Okung can regain full functionality.

Prognosis & Treatment

There are three grades of this type of injury. Grade 1 was mentioned above. Grade 2 consists of a partial tear to the ligament, and is characterized by severe pain and inflammation. Grade 3 is a full tear, and along with pain and inflammation there is also joint instability, which can lead to dislocation.

Because Okung was walking on the sidelines, and wasn't immediately placed on IR, I believe that he has a severe Grade 2 sprain.

There really are not too many different ways to treat this type of injury. We heard today that Okung will not be placed on full Injured Reserve, so I'm guessing he will be avoiding surgery (at least for the season). The issue is that the recovery time for this sort of injury is VERY dependent on outside factors. I knew that the prognosis was hazy, but when I questioned Jene Bramel M.D., he replied with "0-X weeks, depending on severity, pain tolerance..."

Well, we know it will not be zero weeks. And because he is now IR-DR, we know it will be at least six until he can practice. A typical Grade 2 sprain will limit a person for 1-2 weeks, and during that time their foot will be taped, and placed in a walking boot. The patient will limit the weight they place on their foot. Ideally they will remain immobile. A typical Grade 3 sprain will limit a patient anywhere from 6-16 weeks, and can take 6-12 months to fully recover from. During this time they will be immobilized, so as to limit any action in their affected foot. Increased weight bearing, outside of the allowed, can increase the patient's chances for exacerbation, or prolonged treatment.

The issue with this injury is that blood flow to this location is minimal compared to elsewhere in the body, which causes it to be a very slow healing injury.

Because of Okung's position, lateral agility (especially on his outside foot) is incredibly important. This shows itself most in pass protection. If not treated, everytime Okung kicks out, severe pain will lance its way up his leg. Even if he is given strong pain medication, his balance will be cripplingly diminished.

The best treatment for him, is to limit the weight he places upon his foot, and allow the ligament to regenerate naturally. Once the season is over, he will most likely have his foot reevaluated, and surgery may be in his future. This is the type of injury that can linger for a lifetime, and drastically alter the trajectory of a player's career, if not treated adequately.

Turf Toe is often treated with creative taping, and sometimes a cleat with a metal plate that limits dorsiflexion is used.

1230552-1232101-1236962-1237063_medium

The Form of Protective Boot Worn For Immobilization Purposes

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Turf Toe Taping (alliteration)

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