Foot & Ankle International - 2017 FAI Supplement - 44S

disrupted, it does not cause planovalgus deformity until the foot
is cyclically loaded. We hypothesise that the next structure in
the sequential failure cascade is the tibionavicular component
of the Deltoid complex(TN) . With the failure of the SLC and
the secondary effect of the posterior tibial tendon this ligament
is the gatekeeper to stability of the midfoot, preventing plantar
subluxation of the talus, and maintaining the radiographic lateral talo-first metatarsal angle.
Methods: A prospective case control study using a novel
MRI technique to image the TN. We scanned 20 consecutive
normal feet and 20 with clinical and radiological AFFD. The
AFFD group was subdivided into normal or abnormal TN.
We assessed for pathology in the SLC, deltoid ligament
(with conventional sequences) and posterior tibial tendon
(PT). Imaging of the TN was performed using a novel
sequence, which was an oblique view in both T1 and T2
sequence in the plane of the TN ligament to identify the
normal ligament in the control group, and compare it to the
patients with clinical AAFD.
All patients had weight bearing AP and lateral radiographs
in order to measure the calcaneal pitch, lateral talo-first
metatarsal angle, and talo-calcaneal angle. We followed up
patients, the end point being surgery or definitive conservative management and discharge.
Results: 2 distinct groups of patients were identified.
Normal TN(11/20)
A mixture of medial ligament pathology was associated
with this. All were managed conservatively and discharged
from follow-up. The mean Meary's angle was 6.8°.
Abnormal TN(9/20)
The ligament was thickened proximally, with distal attenuation and intrasubstance oedema. On sagittal sequence it
had the appearance of an omega( O ), with dorsal bulging
and high signal on T2. The mean Meary's angle was 13.2°(p
0.013). All patients had PT dysfunction and 8 had SLC
attenuation. 5 of these patients have undergone corrective
surgery. None had been discharged.
The prevalence of the omega in AFFD was 30%. We confirm that the prevalence of deltoid involvement in AFFD is
high, particularly in patients with more severe disease.
Conclusion: Imaging of the TN is valuable in AFFD, and
adds no cost or risk. There is no doubt that sequential failure
of the medial ligaments occurs in AFFD. We have shown
that the deltoid is involved more often than previously
reported. In those with normal TN, our preliminary findings
suggest that management can focus on protecting the medial
structures. When the TN is attenuated('O' on MRI), this
represents a foot transitioning to a more severe deformity,
44S

both clinically and structurally. From our experience, these
patients are more likely to have a progressive, less flexible
planovalgus deformity, often requiring corrective surgery.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00040
©The Author(s) 2017

Optimal Time to Return to Play and
Performance After Jones Fracture
Surgery in the National Football
League
Selene Parekh, MD, MBA, Jay Shah, MBA
Category: Midfoot/Forefoot, Sports
Keywords: Jones Fracture, National Football League,
Return to Play
Introduction/Purpose: While rare, Jones fractures represent
an acute and devastating injury to National Football League
(NFL) players. Although Jones fractures in the general population have been researched extensively, not much is known
about the epidemiology and post-injury effects of these fractures on the professional football athlete. Furthermore, early
season injuries to high-profile NFL players have led to an
increased pressure to return to play more quickly. It is
unknown how this accelerated timeline to recovery affects
post-injury performance and post-surgical complications
necessitating repeat surgeries. Therefore, the objectives of
our study were to produce an updated epidemiology of Jones
fractures and analyze how quicker recovery times affect postinjury performance and re-fracture rates in NFL players.
Methods: Several online sources including a compiled injury
database provided by FantasyData, NFL news sites, and
injury reports were cross-referenced to conduct a retrospective identification of all NFL players sustaining a Jones fracture injury necessitating surgery from the 2010-2015 NFL
seasons. For each injury, time to recovery and return to play
was obtained, and players were separated into two groups:
those returning to play in less than 9 weeks from surgery and
those returning greater than 9 weeks after surgery. Each
included player was followed to identify repeated surgeries
for the same injury. Yearly player performance metrics were
also obtained and recorded for all players. An "approximate
value" algorithm, commonly used to standardize and track
player production across positions, was adapted to calculate
yearly performance values for each injured player up to 3
years before and after each Jones fracture surgery, allowing
each player to serve as his own control.
Foot & Ankle International 38(1S)

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