What key fantasy player on the Houston Texans hasn't missed time due to injury this year? A few days ago the best answer might have been Matt Schaub, but not any longer. To make matters worse, Schaub's injury appears as if it will be season-ending. Schaub suffered a Lisfranc injury to his midfoot and is being evaluated by specialists this week to determine the course of treatment, which may include surgery.
According to the Houston Chronicle, coach Gary Kubiak indicated Schaub's injury happened during a quarterback sneak. "Somebody fell on the back of his foot, and his foot got caught in the pile," Kubiak said. A force placed on the heel while the athlete's forefoot is fixed firmly on the ground (picture a push-off position with the heel in the air at the time the load is sustained) is the most common mechanism for this type of injury in football. It is often difficult for the athlete to continue to play, and in the most serious situations, it is virtually impossible to bear weight. The surprise with Schaub, who managed to play the majority of the game in spite of the second-quarter injury, came Monday when the team discovered just how significant the injury was. According to the Chronicle, the Texans were "stunned" by the news.
Other noteworthy players have suffered Lisfranc injuries -- some severe enough to require surgery -- and have returned to play, although in some cases not to their prior level of play. Running backs Ronnie Brown (injured while a member of the Miami Dolphins in 2009) and Kevin Jones (injured while with the Detroit Lions in 2006) went through lengthy rehabilitation efforts, as did Indianapolis Colts defensive end Dwight Freeney, who was injured in 2007. Although the term "Lisfranc" is more easily recognizable now that several prominent athletes have suffered the injury, what it describes remains a mystery to most. Many have asked on Twitter "What exactly is a Lisfranc?" to which the only response is that the answer deserves more than 140 characters. To help explain the complexity of the injury, along with the origin of its unique name, I returned to an entry I wrote in 2007 when Freeney was recovering from his surgery:
So what is this thing they call a Lisfranc injury? There is a region in the middle of the foot where the long bones of the forefoot (metatarsals) articulate with the small tarsal bones in the middle of the foot. This joint is thus called the tarsometatarsal joint. It is also referred to as the Lisfranc joint.
Why? Frenchman Jacques Lisfranc, a field surgeon in Napoleon's army, described an amputation technique through this region to address forefoot gangrene following frostbite. There is also the story that soldiers wounded in battle would fall from their horses, but a foot would often remain caught in the stirrup, right at that tarsometatarsal joint. Such an injury often resulted in amputation of part of the foot, from the injured joint forward. In fact, amputation to that region still bears the same name (although NFL players, thankfully, don't need part of their foot amputated when they suffer Lisfranc injuries).
Since NFL players aren't riding horses, how does this injury happen to them? There are several mechanisms for this type of injury, but in sports, especially football, the primary scenario is that the player is running forward, with his weight on the ball of his foot, and he gets hit or stepped on from behind against his heel. The resultant force through the portion of the foot in between the ball and the heel (midfoot) causes it to buckle, and the midfoot is injured.
Are all Lisfranc injuries the same? No. In fact, the name Lisfranc refers to the region of the foot, not necessarily the severity of the injury. By virtue of its important location (the midfoot essentially forms the arch), any injury to this region needs to be taken seriously. That said, not all Lisfranc injuries are created equal. When the midfoot buckles, the ligaments that connect the various bones can become damaged. Ligament injury without any bony impact would be the mildest version of a Lisfranc injury. The problem is that damage to the ligaments can affect the relative position of the bones in the area, and they can shift or dislocate, which is often accompanied by a fracture. Now it's getting more serious. In the worst-case scenario, an artery passing over that area can also be damaged, affecting blood supply to the foot. A shift of the bony alignment typically requires surgery to realign the joint and provide stability. Failure to do so can result in chronic instability and pain, eventually leading to major arthritis in the area. Even with surgery, it appears that people who have suffered a significant Lisfranc injury are more at risk for arthritis down the road, simply because of the trauma to the joint.
The bottom line is that players who suffer these injuries must have their treatment managed carefully, not only with surgery, but in the postsurgical rehabilitation process as well.
Apparently it was a bad week to be a quarterback named Matt when it came to injuries. Kansas City Chiefs signal-caller Matt Cassel suffered an injury to his right (throwing) hand near the end of Sunday's game that coach Todd Haley said was "significant and could end his season." According to the Kansas City Star, Haley said Cassel's injury will require surgery, although specific details as to the structures involved were not provided. Looks like it will be Tyler Palko facing the New England Patriots next Monday night. Nothing like jumping in under the bright lights.
Maybe it was just a bad week to be a quarterback whose name starts with the letter M. It only took two plays into Sunday's game for Philadelphia Eagles quarterback Michael Vick to suffer another injury, this time two broken ribs. According to the Philadelphia Daily News, coach Andy Reid says Vick broke his two lower ribs but the severity of his injury was not immediately obvious. As to whether Vick will be available this Sunday, Reid was uncertain. "We'll see. I'll see in the next little bit. He's a tough nut." Maybe. But his ability to throw effectively may be compromised by the injury (which perhaps we saw on Sunday). His status should become clearer later in the week.
And then there were several more season-ending injuries, including two to offensive players who may be on your fantasy roster. Denver Broncos running back Knowshon Moreno tore his right ACL, effectively ending a season that had already been limited by hamstring injuries. Teammate Willis McGahee came out of the same game with a left hamstring strain, but the Denver Post reports he has been cleared to return to practice Tuesday. If McGahee has a solid practice, he could start Thursday night. Meanwhile, Washington Redskins rookie wide receiver Leonard Hankerson's season came to an abrupt end when he injured his hip in the fourth quarter, leaving the stadium afterward on crutches. According to the Washington Post, Hankerson suffered a torn labrum. Fortunately for him, youth is on his side and he should make a full recovery.
• The New York Jets will return to action Thursday night to face the Denver Broncos, just four days after their difficult showing against the New England Patriots. We know the Broncos will be without Knowshon Moreno, but will the Jets also be down a running back? It certainly appears that will be the case, as LaDainian Tomlinson suffered a sprained MCL in Sunday's contest. While the MRI reportedly showed no major damage, four days' rest is a very brief recovery period. Tomlinson was not practicing with the team Tuesday, generally the biggest practice day before a Thursday night game. Fantasy owners who were hoping for a flex play from Tomlinson are advised to look elsewhere.
• Uh-oh. Scott Brown of the Pittsburgh Tribune is reporting that Pittsburgh Steelers quarterback Ben Roethlisberger has a broken right thumb. However, the Steelers are on a bye this week, and according to Brown, Roethlisberger says he will play in Week 12. But it's best to keep an eye on practice reports heading into that week.
• Now that Matt Schaub is out, quarterback Matt Leinart will take over under center when the Houston Texans return to action in Week 12. All indications are that wide receiver Andre Johnson will be there to help him out. Coach Gary Kubiak said he expects Johnson to participate in practice in advance of the next game, although he acknowledged nothing is set in stone.
• Even if Michael Vick does return to action for the Eagles on Sunday, he could very well be without receiver Jeremy Maclin. Maclin suffered not one but two injuries Sunday, a sprained AC joint (commonly referred to as a separated shoulder) and a hamstring injury. Maclin suffered the shoulder injury in the first half but returned to the game, then exited for good in the fourth quarter after straining his hamstring. Jeff McLane of the Philadelphia Inquirer reported following Sunday's game that Maclin was moving "very slowly and with a limp." On Monday, coach Andy Reid said the shoulder injury was the more serious of the two. Either injury on its own could be enough to limit Maclin. We will see whether he is able to return to practice this week.
• San Francisco 49ers running back Frank Gore returned from a left ankle sprain to play in Sunday's game but delivered no fantasy points. It wasn't even his ankle that was the issue. Gore took a hard fall on his knee but emerged with only a bruise, according to Matt Maiocco of CSNBayArea.com. However, running backs coach Tom Rathman did not want Gore to return to the field and risk further injury. Gore has indicated he does not expect to miss any playing time, and Maiocco says Gore was walking without a limp Monday, another encouraging sign. The San Francisco Chronicle is echoing the sentiment, reporting coach Jim Harbaugh expects Gore to play. Harbaugh also expressed confidence in "the stable of backs" the 49ers have available, which could hint at a timeshare. The Niners will have a Thursday night game following this Sunday's contest, so spreading the workload around could be a strategy.
• The Detroit Lions do not expect to have running back Jahvid Best this week. Perhaps the most telling quote from coach Jim Schwartz when asked about Best was, "We're status quo with that." According to the Detroit Free Press, Schwartz added, "When we get clearance from the doctors, we'll get him back. But he needs to be symptom-free before we get clearance from the doctors." The inference there is that Best is not yet symptom-free, and as is typical with these injuries, there remains no timeline.
Teammate Calvin Johnson was evaluated for a concussion following a big hit in Sunday's contest but passed his tests, according to Dave Birkett of the Free Press. Johnson says he will play Sunday against the Carolina Panthers. Quarterback Matthew Stafford is also expected to play, despite a fractured index finger on his throwing hand. Stafford entered the game with the injury, which went under the radar with the Lions on bye in Week 9, but it became a topic of conversation after Stafford's less than, well, Stafford-like performance. The Free Press reports that Stafford blames the gusty winds for affecting his play more than the finger. Hmmm. It's difficult to imagine between the tape on his finger and a glove over the tape that there was zero effect from the injury, but Stafford has never made excuses based on his health as long as he could physically take the field. We'll see. This week the Lions play at home, in a dome. No wind there.
• Atlanta Falcons wide receiver Julio Jones left Sunday's game early because of a hamstring injury. The Atlanta Journal-Constitution reports this injury is to Jones' right hamstring, the opposite leg of Jones' prior injury that caused him to miss Weeks 6 and 7. His status for Week 11 is uncertain.
• Fellow rookie receiver A.J. Green also had an injury scare Sunday when he landed awkwardly during a touchdown grab in the end zone, hyperextending his right knee. Although his knee was stiff, Green told the Cincinnati Enquirer he did not hear a "pop," usually a good sign, and a follow-up MRI that came back negative was even more encouraging. The Cincinnati Bengals expect him to play Sunday.
• It's too soon to have any meaningful update on New York Giants running back Ahmad Bradshaw, who sat out Week 10 to rest his healing foot. Bradshaw had improved to walking without pain last week. The key will be when he can progress to running. As coach Tom Coughlin told ESPN New York, "There is no sense speculating. He is going to have to go out and practice." Let's see if he does just that.
• Cleveland Browns running back Peyton Hillis (hamstring) has already been ruled out for Week 11. No word on Montario Hardesty's status (calf) just yet, but we will need to see if he can return to practice.
We will continue to update these injuries and others as the week progresses.