Minnesota Timberwolves rookie center Justin Patton broke his fifth metatarsal — the long bone on the outside of the foot that connects the pinky toe to the small tarsal bones of the midfoot — in early July and it still isn’t completely clear when he will make his return to the court.
Patton’s injury hasn’t been discussed much beyond the occasional pre-game update and the trouble with discussing it — at least for nerds like me — is that his true diagnosis was never truly revealed. The Wolves described the injury simply as a “broken fifth metatarsal” in their press release and although that may seem specific on the surface, it’s actually rather vague.
The fifth metatarsal can be fractured in multiple locations. They can occur at the distal (toe end), shaft or proximal (heel end) of the bone, which itself can be broken in three places, and they can be acute or chronic (stress fracture) in nature. The most infamous of the fifth metatarsal breaks is the dreaded Jones fracture, which occurs at the middle portion of the proximal end of the bone.
For those interested in the finer details: the proximal portion of the fifth metatarsal is known as the tuberosity and can be divided into three zones aptly names Zone 1, Zone 2 and Zone 3. A Jones fracture occurs at Zone 2 and is usually caused by combined inversion and plantarflexion of the foot, also known as “rolling” the ankle. A fracture occurring at Zone 1 is an avulsion fracture, meaning the very tip of the tuberosity, which is attached to the tendon of the fibularis longus muscle, is ripped away from the rest of the bone. This fracture also occurs via combined inversion and plantarflexion.
Fractures at Zone 3 are typically chronic in nature.
Although it’s unknown, and perhaps unknowable at this point, which specific break Patton suffered, it shouldn’t have affected his rehabilitation too significantly. Rehab for all fifth metatarsal fractures is pretty similar, beginning with light range of motion exercises in the first couple of weeks while the patient is non-weight-bearing and in a cast, and progressing to basketball-specific activities over the course of 8-to-10 or more weeks.
The focus of rehab is typically on improving range of motion in all available movements of the ankle — dorsiflexion (pointing the toes up), plantarflexion (pointing the toes down), inversion (pointing the toes in), eversion (pointing the toes out) and all of their combined movements — as well as strengthening all of the major muscle groups of the lower extremity, from the hip to the ankle. The player begins participating in activities related to basketball after roughly 2.5-3 months post-surgery — such as practice — and is progressed from non-contact drills to those with contact (3-on-3, then 5-on-5) before eventually being cleared for game action.
This usually occurs after 3-to-4 months.
However, Jones fractures can have a prolonged timeline for return to play as they are more prone to nonunion, or improper healing. The blood flow to Zone 2 of the tuberosity of the fifth metatarsal is rather poor compared to other areas of the bone and without adequate blood flow, the nutrients and cells that are needed to promote healing can’t get to where they need to go. If this is the case, rehab can be extended for an indefinite period of time and other surgical procedures may be required.
There is no indication as of this writing that Patton has suffered any setbacks in his rehab. He’s about 4.5 months into his rehab, but as Tom Thibodeau was quoted as saying above, there really isn’t much reason to rush to bring Patton back. He’s a raw, promising talent — particularly in the pick-and-roll and in transition — but he was always likely to see most of his time with the Iowa Wolves this season anyway. Bringing Patton along slowly with his rehab and eventual return allows him to not only heal properly but also gain experience via watching film and games from the bench and participating in practice.
The question that always seems to arise when a big man injures his foot is what kind of impact will the injury have on his future, will this be a chronic issue moving forward?
The short answer is that it is too early to tell and that everybody heals differently.
That being said, a slow, conservative rehab is likely the best way to prevent injuries in the future. As stated before, not only does an increased rehab timeline allow for proper healing of the broken bone, but it also allows the player and rehab staff to address possible factors that lead to the injury in the first place, such as impaired range of motion, muscle weakness, and faulty biomechanics.
Patton will be back at some point in the relatively near future, but when exactly is still up in the air. However, the Wolves are doing their best to bring him along in a way that is best for not only his short- and long-term success, but also for the team’s as well. Fifth metatarsal fractures aren’t an injury to take lightly and it appears as if the Wolves are treating Patton’s injury as such.
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