Joey Bosa Foot Bone Bruise & Tendon Instability: Better Safe Than Sorry

The Los Angeles Chargers’ Joey Bosa hasn’t played this season due to a bone bruise and tendon instability in his left foot.  The bone bruise initially occurred on August 7th during 11 on 11 drills and was considered a minor injury.  However, Joey Bosa self-admittedly rushed back and ended up injuring his foot again (he called it a re-aggravation but Chargers Coach Anthony Lynn said it was a different injury).

Since that point, the team has been very conservative and Joey Bosa just recently got out of a cast and was placed into a walking boot.  His targeted return date is the November 4th game against the Seattle Seahawks, after the Chargers’ week eight bye.  If that timeline holds, it puts Joey Bosa’s recovery at nearly three months.  That’s a long ways from that initial “minor injury”.

However, that timeline is pretty reasonable once you understand his injuries.  To do just that, lets go through the two injuries in more detail.  Lets start with the bone bruise:

I. Joey Bosa Left Foot Bone Bruise

A bone bruise – unlike the typical bruise that’s just broken blood vessels underneath your skin – involves a microfracture of the bone (technically, it’s called a “microtrabecular fracture”).  In terms of severity, a bone bruise is considered one step below an actual fracture.

Here’s a visual of a bone bruise (this is of the knee but it gets the point across):

joey bosa
Credit – MD Health

A bone bruise has multiple sub-types but I’ll spare you all the details. Regardless of type, a bone bruise is notoriously painful and can linger for awhile.

I’ve had one — keep your head on a swivel at any four way stops while biking— and it thoroughly sucks because bone is densely innervated with nerve endings which means a lot of pain.  Additionally, swelling can travel from the bone to the muscles around it (in the case of Joey Bosa, other muscles in his foot) which means more pain and limited function.  Lastly, the foot has multiple nerves – including the superficial peroneal, lateral plantar, and medial plantar nerves – that are near the foot’s surface and prone to irritation.
joey bosa
Credit – Erik Dalton

joey bosa

These surface nerves can become irritated after a foot bone bruise and cause additional symptoms like tingling, numbness, feelings of “tightness,” etc.

For all these reasons, a bone bruise can linger for weeks to multiple months. Additionally, the foot constantly bears weight and pressure which can exacerbate the pain and bone bruise further, resulting in an even more nebulous timeline for recovery.

To add the cherry on top, Joey Bosa is also dealing with…

II. Joey Bosa Left Foot Tendon Instability

In a recent interview, Joey Bosa said that he’s still dealing with instability in the tendon of his left foot and he blamed rushing back too soon from the initial injury as the cause.  My educated guess is that he was trying to play through pain which led to changed mechanics and compensations in the rest of his foot, resulting in excess stress and eventual instability in a foot tendon.

I haven’t found any information on which specific foot tendon is causing problems for Joey Bosa but what we do know is that an unstable foot tendon can completely alter foot function. That’s because a tendon (which is a flexible but inelastic cord of tissue that attaches a muscle to a bone) is critical for movement (working in conjunction with the muscles):

joey bosa
Credit – AssignmentPoint

And the foot is full of them.

joey bosa
And that’s just the top outer half of the foot! Credit – Adobe Photos

Each tendon is like a pulley that has its own groove and line of pull. If that pulley (tendon) becomes unstable, then the foot can’t function normally and sets up a high risk situation. Over time, an unstable tendon will become weaker and may eventually rupture (completely tear).

Check out this visualization (it’s the finger pulley system but similar concept to the foot):

joey bosa
Credit – Neumann

Joey Bosa understands that risk, recently saying:

“If I would have went out on game day I would have destroyed my foot.”

To prevent that, his foot was casted and then placed into a walking boot to take pressure off and allow the tendon to heal and re-stabilize while not being disrupted by movement. However, if that conservative treatment isn’t enough, surgery will be required to manually stabilize the tendon.  Here’s Joey Bosa chiming in again:

“Right now we’re really trying to prevent surgery, which is looking good as long as I take my time and do everything right.”

III. All in All

All in all, Joey Bosa has suffered two pretty annoying injuries to the same foot. The first, the bone bruise, is very painful and can linger for awhile especially when it’s in a weight-bearing region like the foot.  The second, the tendon instability, adds more pain while changing the mechanics and function of the foot with the potential for very serious injury if not handled correctly.

Not a very fun injury combination.

I’m not too concerned about the bone bruise because they heal in due time. However, the tendon instability is concerning because there’s a chance that as Joey Bosa ramps up his activity level in preparation for a return, the tendon can’t handle the stress and remains unstable. In that case, he’ll end up having surgery and more than likely end up missing the rest of the season.

We’ll find out come November 4th.

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Posted in NFL

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