September 25, 2025 • 25 mins
Turf toe has sidelined Brock Purdy and Joe Burrow, affecting legends like Patrick Mahomes and Deion Sanders. But what exactly is it — and why does it matter so much?
In this episode, Will Sanchez and Orthopedic Surgeon Dr. Grant Garcia break down:
The anatomy and mechanics of turf toe
Why is this injury devastating for quarterbacks
Differences in severity (2–5 weeks vs season-ending surgery)
Modern treatments: taping, custom orthotics, internal bracing, biologics
Lessons from past stars like Deion Sanders and Serena Williams
Get the full medical perspective on an injury that can define seasons and careers.
Special thanks to The Recovery Shop for sponsoring this episode.
Check us out at sportsdoctalk.com for transcripts, guests' requests, and much more.
00:00 – Intro & NFL injuries this season
02:00 – Shoutout to The Recovery Shop
03:10 – What is turf toe, anatomically?
05:45 – Why it kills explosiveness in athletes
08:15 – Brock Purdy vs. Joe Burrow: different severity, different outcomes
12:00 – Risks of playing too soon & custom braces
14:00 – Why it’s called “turf toe” & the need for rebranding
15:30 – Deion Sanders then vs. modern treatments now
17:00 – Internal bracing revolution in sports medicine
20:00 – Cartilage damage, sesamoid fractures & long-term risks
22:00 – Can cleats, training, or AI help prevent turf toe?
24:00 – The future: prophylactic bracing & biologics
25:00 – Closing thoughts & visit sportsdoctalk.com
#NFL #SportsPodcast #BrockPurdy #TurfToe #SportsMedicine #AthleteRecovery #SportsDocTalk #JoeBurrow #DeionSanders #FootballTalk
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:16):
Welcome to sports dot talk. I'm Will Sanchez and that man
that you see there if you're watching us on YouTube is Doctor
Grant Garcia, our orthopedic surgeon in sports medicine
specialist Doctor Garcia. This will be a really
interesting conversation, but animportant one.
It's been an exciting NFL seasonunless you're a giants or jets
(00:38):
fan. So let's not get into that.
Once again, the New York team start out O and six, and I may
need some therapy. I may need something stronger
than water. But anyway, how are you?
What's going on? Outside of the Giants, I'm good,
things are good. You know, it's unfortunately end
of summer in Seattle here, but we're still getting a few more
(01:00):
sunny days and yeah, it's been good everything's going well.
I'm excited to talk about this topic.
It's, it's interesting 'cause it's kind of like you hear it,
but you don't really see it thatmuch and you heard about it,
everyone knows about it. You know, the doc that's doing a
lot of these surgeries, but you know, it's just one of those
ones. It's kind of like the hidden,
the hidden injury. We don't talk about too much,
(01:21):
but it really effects people significantly.
Yeah. And before we get into the
topic, I mean, we can talk injuries every single week.
I mean, we could turn this show into that once again.
Nick Bosa torn ACL out for the season, CD Lamb high ankle
sprain. We've talked about that in the
past three to four weeks, but that's that can be something
(01:41):
that just lingers for a lot longer.
Naji Harris is out with a non contact football foot injury and
James Conner severe ankle injury.
We're talking about major, majorstars in the NFL that are hurt.
We had five quarterbacks last week starting quarterbacks that
didn't play. So this is this is something
(02:02):
that reoccurs. It's part of the business.
It's why we love the game, just because it's exciting.
It's fast-paced, but there comesa cost.
And with that cost as they get recovery, you know who's gonna
shout out? We're gonna shout out Mike B at
the recovery shop. Doctor Garcia, man, let's talk
about the recovery shop a littlebit.
Yeah, shout out to our sponsors.They've been awesome for the the
(02:24):
last year or so since we've beenworking with them.
But you know, they're, they're really great.
I honestly, I have them in my practice and my patients always
asking about this and always complimenting about this ability
to order sort of aftermarket things that'll get them back
like the nice machine or you know, more innovative braces or
more innovative machines like the Rebliss.
Like the ability to have that option in all in one area is
(02:47):
really great for your patients from a recovery standpoint and
working towards more nutrition, which again, we've had two
nutrition specialists that are doctors on the show.
So you know, it's, it's, it's not just about the surgeries,
these cool things we'll talk about.
It's about the post operative care and that's really what they
specialize in. So we chat to them.
If you're a surgeon, if you're apatient, talk to your surgery
surgeon, they might be able to offer it.
(03:08):
So. You know, the topic that we're
going to get into is turf toe and, and it's a it's a great
segue, especially what happened with Brock Purdy.
He's supposedly going to be out for a few weeks and we're going
to get into some of those things.
When I think of turf toe, Patrick Mahomes recently, you
know, a few Super Bowls ago, he played through it.
(03:28):
I can't imagine the pain that goes through it.
And you're going to explain why that is.
And then Deion Sanders, you know, anyone that knows Dion,
that knows about his story, you suffered through this injury
that pretty much led to amputation of toes.
So it is it, is it? That's a funny name, Turf toe.
It doesn't sound like a strong football player should be out
(03:50):
for the season or out for weeks with a name like turf toe.
But what is turf toe anatomically?
You know, what what what, what structures are affected by this?
Well, so, yeah, so let's show that diagram so it's easier to
describe to our listeners. Yeah, that's a good one.
We can do that one first. So we're talking more about the
(04:11):
Joe Burrows thing, right? He's going to have surgery now
on this. It's a really big deal.
But again, it's so small and you're kind of like, what are
they dealing with? And you know, this may be what
Malik Neighbors is dealing with.They don't really talk about his
toe injury. He had, you know, there's all
these recurrent injuries you hear about with players, and
we'll go into some of them. But basically this is that the
first the big toe and we're connects to what we call the
(04:33):
metatars. So that's the long shaft there.
And underneath that there's something called a plantar plate
and that plate gets torn out here is not the best anatomy.
So if you want to go to let's goabout two slides, I think over
one more, you're perfect right there.
So you can see this is again a really anatomic figure You
underneath that you have the tendons that allow you to flex
(04:53):
the big toe and then underneath that is a capsule and a plantar
plate. Now in that tears, The thing is
when you have it on your foot, the most important toe is that
big toe for planting flexion andexplosion.
And just the tear of this can reduce your explosiveness
significantly to the point now where basically you go from an
NFL player to to a recreational athlete, right?
(05:13):
And it's pretty impressive that they can be knocked down that
far, but you lose your explosiveness.
And this has been a problem for a number of NFL players and it
happens outside of the NFL too. But this is a big deal.
And so that's what happens here now sometimes, which we'll talk
about in the potential surgical,you can see there there's
something called these little sesamoids.
They're tiny little bones that sit in the middle of this sort
of ligaments, these all these accessory ligaments and
(05:34):
everything else. Well, those can be injured too
with this. Now, again, it's like, it's like
we talked about a knee sprain, right?
It's not just a knee sprain. It may be an ACL, it might be a
meniscus, it might be cartilage damage, right?
The turf toe has various degrees.
You can get cartilage damage of the two joints just like you can
get cartilage damage to the knee.
And you can tear these the plantour plate and split these
(05:54):
sesamoids or you can tear the sesamoids or you can fracture
the sesamoids. And so there's various different
things that can happen with that.
Now we don't know exactly which one he got, but we know that Joe
Burrows is probably a high level1 given the fact.
That he had, yeah. Yeah, yeah.
Yep. So how, how do you grade it from
mild to severe? What are you looking for when
(06:14):
you're assessing that? When he comes over from the
sideline saying you know, I've got the discomfort, what are you
doing there? So the first thing you're doing
is you're, you're looking at this and you're trying to assess
like you basically are going to test that ligament out and
you're going to basically try toextend the toe, flex the toe
down and you're going to, I mean, you pretty much can
(06:36):
probably make some of your diagnosis there.
But really the key here is goingto be that MRI.
So to look and see whether or not it's the, you know, what
we're dealing with. And so that's.
Is there anything instantaneously like, you know,
obviously you, you tear your Achilles, you squeeze the calf.
If the foot just dangles and doesn't flex, then you know that
it's, you know, the Achilles haspopped.
(06:57):
Is there anything that you can see on the field right away or
is it something that is just a pain threshold and then you have
to get to an MRI? I mean, generally your NFL,
you're going straight to that. So, you know, that's a
combination of of both and for us to clarify for the players,
so the Joe Burrows underwent thesurgery just recently and Brock
(07:18):
pretty also got the injury. So actually we're talking about
two players here. So Burrows, it looks like he
went actually to the Andrews Institute, interestingly enough
to repair it, but I was under the impression he was going to
go to Bobby Anderson. So that's a that's an
interesting finding. But Bob may have flown down
there to help out because he's one of the Green Bay Packers
team doctors. So sorry, let's continue on.
(07:39):
So the so you're going to get the every all these players, all
these players are going to get Mris and they're going to get
them on the next day. I mean, when we were taking care
of the Giants, we would have Monday morning MRI review of all
the players that were injured during the week.
And then we'd go through them and say, OK, this is what it is.
This is what it is. So they've got the MRI the next
day. OK.
(08:00):
And then you don't think that's something, if they're at their
home stadium, that they could godo well at that point, they're
still kind of in the middle of the game.
They're not going to do it mid game probably because it just
doesn't make any sense to do it.It's not urgent enough to do
that and it wouldn't generally right.
It's always about like, what would the management do, right?
You get the X-ray, make sure they don't think broken.
If not broken then and they're good enough to play, then maybe
(08:23):
they put them back in. But if they're worried enough
for this situation, they're out for the game, right, And then
they're going to re evaluate on Monday in the facility because
it's kind of a standard practice, right?
You want your own radiologist tolook at it like a lot of these
teams, even if the let's say allthe radiologist, I mean, we know
a lot of these doctors, they're all great.
Like, you know, they as much as they like appreciate the team
position, taking a look at theirguys, they're like no, no, no,
(08:44):
no, we'll take care of it. This is our team.
They're very possessive of theirplayers, which is totally
acceptable. You just want to keep everything
in inside so they'll fly. I mean, we know this how this
works, but pretty much every time a player, when they finish
their game, even if it's 10:00 at night, they're hopping on the
private plane and they're flyingstraight home and they land at
4:00 AM and then again MRI at 8:00 AM.
(09:05):
So they're, they're always at home the next day.
Unless there's some sort of unforeseeable storm, they can't
make it. But it it they're getting this
MRI as soon as possible. All right, So explain the
severity difference between a Brock Purdy that they said, I
don't know between two and five weeks, which to me is that's a
pretty big range. When you say 2 to 5 compared to
(09:28):
a, you know, Joe Burrow, that possibly could be the season
that if they haven't already declared him out for the season
yet. I think he's out now because he
had just had the surgeries. I'd be shocked.
Maybe he'll get back, but we cantalk about ways that people are
accelerating those. OK, You know you have different
levels. You have grade 1-2 and three.
So you know the Grade 1 is just sort of a sprain.
Grade 2 is a sort of partial tear of the turf turf toe and
(09:52):
that's the mild turf toe injuries.
When you do kind of rest, you tape them anti inflammatories.
That's about a two to six weeks.So it's a pretty broad range.
When you get to severe, that's when we have them full rupture.
So he probably had a partial tear of his plantar plate and so
that's why he was in that small level.
But now they're finding out again, this is similar to many
of the injuries we're seeing that like sometimes when you
(10:13):
have these full tears, it's faster to fix them and more
reliable the player back out there more than a partial or
than just continuing to non opt them right.
Like we know that like some of these players that we'll talk
about later, it continually had non op treatment, non operative
treatment and they would push limp them along for weeks and
weeks and weeks and then re injure themselves the next year.
(10:34):
And now we're realizing with a lot of these things like, you
know, some of these players are the baseball players, it's like,
you know, they're just not throwing as well, like we should
just pull the trigger and do surgery.
So it's like we're we're learning more unfortunately, in
some cases that surgery sooner, as much as we want to be a
conservative culture that surgery sooner for this with a
fresh tissue or with these newertechniques like internal
(10:57):
bracing, which we'll get into. I know you love that word.
The we there's just we do need AT shirts.
So I mean with that, the there'sno reason why you wouldn't be
more aggressive with this. So mild turf tour is different.
But this planner play or sure, Imean, did you they with
Burroughs? They did.
He'd injured it in like a week later.
They said he's getting surgery, right.
So there wasn't even a question.Well, it was clear.
(11:18):
The MRI clearly indicated that this is yeah, we're done here.
This is not treatable because obviously with someone at his
level, one of the top three top five quarterbacks in the NFL,
you know that they would say no,there's just no recovery from
this. Let's go the route of Brock
Purdy. Let's say it's two to five
weeks, two to six weeks for thatrecovery.
(11:39):
I don't know if you could you fully recover when you know,
when you finally get back on thefield, you're planting, you're
stepping, you're planting, you're throwing, you're running
away from very large men. You know, people are landing on
you. I I don't, it is early in the
season, not Lake where it like happened with Patrick Mahomes,
where he's like, I'm almost at the finish line.
I'm just trying to gut it out. But you still have the whole
(12:01):
season. What what are the repercussions?
What are the what? What is Brock Purdy going to
have to go through for this season?
I mean, it's it's if he gets back too early, he could chance
to re rupture, right? And then he's going to get
surgery on it. The other thing is like, does he
just play, you know, basically with a, with a lack of push off,
right? Is there some sort of he's going
to have some sort of bracing on for a while, even when he gets
(12:24):
back? They're just not going to let
him go full boat unless he's completely pain free.
Maybe an MRI shows he's completely healed.
Remember, the Mris are always good.
On a toe, where does a brace go?Is is it a shoe?
Is it a ankle stability? What?
What do you? Mean it depends on the depends
on the injury. But in these cases, you know,
they have sometimes they have these like extended foot toe
things. So it's like a it's like a it,
(12:45):
it's like a basically like a sole of the shoe, but as an
extended toe plate, like a metaltoe plate.
He might have on there probably wouldn't be able to play with
that. But you know, these guys have
like master orthotics, right? So there's someone in there like
molding these custom things and they're like, OK, let's try
this. Boom, that doesn't work.
Go to the next one. I mean, it's unlimited supply of
cashier. So they can try all these
(13:05):
different things for him and they're going to do literally
everything to get this toe. They're going to use all these
sort of fancy gadgets that we probably haven't even heard
about yet. So I mean, it's going to be
they're going to try everything they can to get him, to get him
back. So rest immobilizing, taping 3D
(13:26):
models of somebody mad scientist, Doctor Frankenstein,
trying to create something that will fit his foot and and in a
kind of a way you go. Next question is why is this
called turf toe? Why don't we have like a cooler
name? Like, you know, when you hear
rupture or you know, tendon, youknow, or you know, ACL knee,
(13:47):
blown turf toe. Can you come up with a creative
way to rename this and maybe we can kind of rebrand this and
take credit for it? What?
What? How would you go?
About that, I can't think of a good name for this because it's
it's, it usually happens in football players.
That's why they call it turf toe.
It's the it's a, it's because ithappens.
And maybe we could just all my discussion we talked about turf
versus grass, but maybe you know, grass toe doesn't sound
(14:09):
any better. So at least.
It's a turf toe. All right, all right.
We're going down to Rex Ryan tree right now with these toes.
We're done with the toes. Let's go with today's
technology, right? Deion Sanders went through this
in the 90s, right? He, he had severe, you know,
with the turf toe, you know, andsomething that lingered.
What are the differences betweenin the 90s when Deion was
(14:33):
suffering through turf toe and probably playing with it where
he probably shouldn't have, right?
You know, and especially with that man up, you know,
mentality, what are the difference from then to now that
you can explain to our audience?Yeah, so go back to that picture
before you can show the fan the new technology which we'll talk
about again, we've talked about this at nauseam, but that's one
(14:55):
more. So this is a picture go back
that's perfect of all the ways we use internal braces now and
this while these some of these things are a little newer, some
of these are a little bit older.This is older in like the last
few years. So they're talking about
internal bracing. Now, if you've been bunions, but
you know you have ankle fractures, you add internal
brace in there to help with the stabilization.
(15:15):
You're doing these sort of anklethe ankle instability talk about
ankle sprains and adding an internal brace.
But you can see there in the bottom left hand corner, there's
plantar Pate internal bracing. And so this is sort of one of
the additions. It's just like the UCL repair
with internal brace, right? Without that internal brace, UCL
repair is not a good surgery. Like very few people to success.
(15:37):
It was very it was very unsuccessful.
That's why for years it wasn't successful.
That's why ACL repairs we talkedabout now saving AC LS because
we add the internal brace. So this internal brace has been
a game changer for these more simple repairs or because in a
lot of cases the repairs sometimes suck like this, don't
do that well. And so now we have so many more
(15:57):
surgeries that we can repair. So we keep the person's native
tissue and avoid adding grass and tunnels and holes.
And that we can do this the moreif we can repair everybody, that
would be the best case scenario.If you can repair all ligaments
that ever got injured, that would be the Holy Grail.
And we're getting closer. We're not there yet.
And of course, there's chronic injuries, which are different
(16:17):
than acute injuries. But now they have this ability
to internally brace the planter plate.
And so as a result, they see that, they see him tear it.
They're like, we have this new surgery and maybe he'll get back
instead of the four to six months, maybe 3 months.
And so three months is not as bad, maybe 2 1/2 months, who
knows. I mean, they tried to get Aaron
(16:38):
Rodgers back again, it was The Jets, but they try to get him
back in 10 weeks after an Achilles rupture because he had
an internal brace as well. So the idea is that these guys
are going to start pushing the envelope on this because
remember in orthopedics, everything goes in like 6 weeks,
12 weeks, four to six months. It's just the way we deal with.
(17:04):
So you know, it's the it's a pretty we have these standard
metrics that aren't always perfectly scientific, right?
You know, you always you've always heard the word it's four
to six months. Like that's a very common
orthopedic term. Takes six weeks for the bone to
heal. Well, doesn't always heal in six
weeks. Sometimes it heals in four
weeks, sometimes it heals in eight weeks.
But we like that word. We like the six weeks, we like
(17:24):
the 12 weeks. We like the way the follow-ups
work. So the idea is that people are
going to keep pushing the envelope on a procedure like
this, But remember, there's other things that go on with
this procedure. So not only is he going to so go
to the two slides over, it's thebest image I could find it
without grossing out the audience and showing an actual
live surgery of this. So now this is not the actual
(17:44):
turf toe repair because this is the second, which is the other
toe. It's the toe next to the big
toe. But this is the same sort of
technique. So what what they do is this
that planter plate, you can see it's popped there in the bottom.
And that's so basically you go on over the Gray toe.
That's what that's how you fix this.
Yeah, yeah. And they were threading the
suture through and then they do this very complicated repair
(18:04):
technique. And then you anchor it on the
other side in the, in addition to that, you add something
called the internal brace. So you add this synthetic
suture, this thick fiber tape and you anchor that on both
sides as well. Obviously there's a little,
there's a little bit room, there's very few room for air.
You can see how small this is, right?
So you really want to make sure you're accurate.
But there's sort of kits and things like that, that that
(18:26):
Arthrax has to help with this aswell.
So that's the that's the first part.
Another part is, you know, adding some sort of PRP or
biologic sometimes can help. We've talked about the
fertilized ACL. We literally just had Chad
Levender on here. I'm having that conversation.
So that's important. And then as you see between
those toes, there's cartilage. And so sometimes that cartilage
(18:47):
is damaged. And so that may be something
that we want to additionally do because if you don't take care
of the cartilage damage and he has it there, it could go on to
being painful. So now you have lost power or
let's say your plantar plate heals great, but now you still
have pain cause the toe has arthritis in between it.
And that's a big problem. And we talked about this a long
time ago, I think it was Serena Williams had this and she had to
have a fusion. So it's not ideal to have
(19:09):
cartilage damage there. So all those things.
And then the last one, which again, little simple injury,
that's so jastic. The sesamoid bones, those little
tiny hole bones that I showed you on the previous thing, if
those are fractured, they can sometimes fix them or take them
out, which is uncommon. But the other thing is they can
tie all this in because those sesamoids live inside of that
plantar plate area with the ligaments.
(19:32):
Those little bones live in there.
You see how they're all connected together, right?
When you do the when you do the dissection doesn't look like
this. I wish it did.
That'd be amazing. Every surgery would be amazing
if it always looked like the picture, right?
But we know that's not real life.
So anyhow, so so the idea is yourepair it all together.
So that's what they did for Joe Burrows.
And I have a feeling that he'll be back faster.
(19:53):
But again, it just depends too about, you know, that the
Bengals don't do well. Like why race him back?
You know, if they're doing really well, maybe they change
their mind on when he comes back.
It's really tricky. I think that's the hardest part
of some of these recoveries is you don't really know what the
true return to sport is for thisplayer because let's say
they're. Let's say now it's September, so
(20:13):
October, November, December, 3 months and they're not even
close to play offs. Why would they put them back in?
Yeah, I I agree. I agree.
You're never going to know. I mean, he could take him.
They're going to say he got backin five months, but he could
have gone back in three. It all depends on when they get
hurt. It's just like all this in
season stuff. Yeah, yeah.
And so think cleats help lead tothese type of injuries.
(20:37):
Is is that common or is this just the way it is, you know,
stressing that area pushing off all of a sudden that you
develop? Or is it maybe 300 LB people
landing on your foot? Yeah, You know, there's lots of
things on there. I'm.
Just wondering footwear as because foot the the cleat is
very different than anything else that we wear.
Yeah, I mean, this is this is a this may be AI mean the
(20:59):
challenge is on the bottom to protect it.
It's different than like ankle sprains, which we may have a
sneak peek at that later on in the next few weeks with some new
episodes being released. But I'm sure there's people that
are looking at it. I mean, anytime an injury
happens, we've looked at the numbers.
It's extremely expensive. I think I texted you recently
that the number we had wasn't even close to what they're
seeing now. They're like talking about in
(21:19):
the in the billions of dollars lost for these players because
it's so much money. What about training?
Is there anything that you can do?
You know, I'm reaching over herewith the bottom of your foot
trying to see if there's anything that you can do.
Is it training? Is it strength?
Is it, is it flexibility? Is it stretching?
I know that there's been these contraptions that you put over
(21:42):
your foot and you can pull, you know, you're doing anything with
band work to just kind of keep that flexion going on in that
area. I'm just curious for what you've
learned and spoken with your colleagues.
Is there anything that says if you do this, you lower the risk
by, you know, 3% or something like that?
So this is a great point. I don't want to belabor this on
(22:03):
the show because it's a lot, butthere is this small sub faction,
people that have started talkingabout prophylactic surgeries,
prophylactic internal bracing. So in these people that are
really high risk, is adding likean internal brace ahead of time
where there's really no recovery, right?
You just anchor it and you just let them go back.
(22:24):
You let the incision heal. Would that protect someone from
having a turf toe? Not in this case, but they talk
about it for ACL tears. Or do you add like a second
ligament back it up so you can prevent the ACL?
I mean, it's a little crazy right now, but the idea of
preventing them, I mean, let's say you kind of knew you're like
this. These, these six players are at
high risk from AI algorithms, right?
(22:46):
What we talked about before, AI in medicine.
So let's say you have an AI algorithm and it shows that like
you, these are your top 2% of players that are at risk of
getting this and you're out for four months or lingers, You're
never the same, right? I mean, some people might
consider it. Or do we do a minimally invasive
thing where you just do 2 micro incisions, you throw the tape
underneath, you avoid the tendons, you do it all under
(23:08):
ultrasound guidance and you can do it in the players back in two
weeks, right? Like we may get there at some
point. So this is this is something to
be considered because if nothingelse is torn, then it's again,
I'm not advocating for surgery that's not indicated or surgery
before someone gets hurt. But but it the concept's pretty
crazy because what was if we allof a sudden didn't and saw that
(23:30):
no one got turf toed for like anentire season?
Yeah. You know, maybe we don't know
that's. Maybe we get to the point where
it's not permanent that you plant something in just for the
season and then you remove it. Or do we have biologics, right?
You start having soreness, you see that you throw biologics in
there. I mean, that's probably where
we're going, 'cause that's the easiest sell to these NFL
(23:52):
athletes is like, hey, you know,like, oh, your toes turning in
the season MRI shows is a small partial tear.
Let's just pump you with a little bit of some PRP or bone
marrow or other stem cell options and then you know, you
heal then you're good. It scars in we got a new MRI.
It looks good. So you know that we're we're not
there yet, but it's there's morethings down the pipeline and
there's things we're not even talking about on the people
(24:14):
we're working on. So.
Yeah. And we're talking about a
billion gazillion dollar industry where the quarterback
position is by far the most valuable position no matter what
anyone says. Well, it's the pass rusher, the
running back, the why receive it?
No, your team cannot function without a a high level
quarterback, as we've seen for the last decade with the New
(24:35):
York Giants. And he didn't even have Turfto.
And he did David have Turfto. This is a this is a great topic.
We're going to have a lot of other topics to follow.
We always want to let everybody know.
Check us out at sports.talk.com for more episodes, transcripts.
And we've had some very welcoming, curious and talented
(24:58):
requests to be on the show. So but keep it coming.
We, we love it. We love to talk to you.
We love that you reach out. So we really appreciate it.
Doctor Garcia, you got anything to put a ball on this or
internal brace on this? Internal brace exactly.
That's right. So I know well, thanks for
listening and yeah, keep the request coming.
We get a lot of requests. So it's it's nice.
(25:19):
It's just again, we want to stayfocused on the sports talk, talk
and you know, all orthopedics, all sports all the time.
So that's our we try to keep that focus for our for our
viewers. All right.
Thank you very much, Doctor Garcia.
Take care.
Welcome to sports dot talk. I'm Will Sanchez and that man
that you see there if you're watching us on YouTube is Doctor
Grant Garcia, our orthopedic surgeon in sports medicine
specialist Doctor Garcia. This will be a really
interesting conversation, but animportant one.
It's been an exciting NFL seasonunless you're a giants or jets
(00:38):
fan. So let's not get into that.
Once again, the New York team start out O and six, and I may
need some therapy. I may need something stronger
than water. But anyway, how are you?
What's going on? Outside of the Giants, I'm good,
things are good. You know, it's unfortunately end
of summer in Seattle here, but we're still getting a few more
(01:00):
sunny days and yeah, it's been good everything's going well.
I'm excited to talk about this topic.
It's, it's interesting 'cause it's kind of like you hear it,
but you don't really see it thatmuch and you heard about it,
everyone knows about it. You know, the doc that's doing a
lot of these surgeries, but you know, it's just one of those
ones. It's kind of like the hidden,
the hidden injury. We don't talk about too much,
(01:21):
but it really effects people significantly.
Yeah. And before we get into the
topic, I mean, we can talk injuries every single week.
I mean, we could turn this show into that once again.
Nick Bosa torn ACL out for the season, CD Lamb high ankle
sprain. We've talked about that in the
past three to four weeks, but that's that can be something
(01:41):
that just lingers for a lot longer.
Naji Harris is out with a non contact football foot injury and
James Conner severe ankle injury.
We're talking about major, majorstars in the NFL that are hurt.
We had five quarterbacks last week starting quarterbacks that
didn't play. So this is this is something
(02:02):
that reoccurs. It's part of the business.
It's why we love the game, just because it's exciting.
It's fast-paced, but there comesa cost.
And with that cost as they get recovery, you know who's gonna
shout out? We're gonna shout out Mike B at
the recovery shop. Doctor Garcia, man, let's talk
about the recovery shop a littlebit.
Yeah, shout out to our sponsors.They've been awesome for the the
(02:24):
last year or so since we've beenworking with them.
But you know, they're, they're really great.
I honestly, I have them in my practice and my patients always
asking about this and always complimenting about this ability
to order sort of aftermarket things that'll get them back
like the nice machine or you know, more innovative braces or
more innovative machines like the Rebliss.
Like the ability to have that option in all in one area is
(02:47):
really great for your patients from a recovery standpoint and
working towards more nutrition, which again, we've had two
nutrition specialists that are doctors on the show.
So you know, it's, it's, it's not just about the surgeries,
these cool things we'll talk about.
It's about the post operative care and that's really what they
specialize in. So we chat to them.
If you're a surgeon, if you're apatient, talk to your surgery
surgeon, they might be able to offer it.
(03:08):
So. You know, the topic that we're
going to get into is turf toe and, and it's a it's a great
segue, especially what happened with Brock Purdy.
He's supposedly going to be out for a few weeks and we're going
to get into some of those things.
When I think of turf toe, Patrick Mahomes recently, you
know, a few Super Bowls ago, he played through it.
(03:28):
I can't imagine the pain that goes through it.
And you're going to explain why that is.
And then Deion Sanders, you know, anyone that knows Dion,
that knows about his story, you suffered through this injury
that pretty much led to amputation of toes.
So it is it, is it? That's a funny name, Turf toe.
It doesn't sound like a strong football player should be out
(03:50):
for the season or out for weeks with a name like turf toe.
But what is turf toe anatomically?
You know, what what what, what structures are affected by this?
Well, so, yeah, so let's show that diagram so it's easier to
describe to our listeners. Yeah, that's a good one.
We can do that one first. So we're talking more about the
(04:11):
Joe Burrows thing, right? He's going to have surgery now
on this. It's a really big deal.
But again, it's so small and you're kind of like, what are
they dealing with? And you know, this may be what
Malik Neighbors is dealing with.They don't really talk about his
toe injury. He had, you know, there's all
these recurrent injuries you hear about with players, and
we'll go into some of them. But basically this is that the
first the big toe and we're connects to what we call the
(04:33):
metatars. So that's the long shaft there.
And underneath that there's something called a plantar plate
and that plate gets torn out here is not the best anatomy.
So if you want to go to let's goabout two slides, I think over
one more, you're perfect right there.
So you can see this is again a really anatomic figure You
underneath that you have the tendons that allow you to flex
(04:53):
the big toe and then underneath that is a capsule and a plantar
plate. Now in that tears, The thing is
when you have it on your foot, the most important toe is that
big toe for planting flexion andexplosion.
And just the tear of this can reduce your explosiveness
significantly to the point now where basically you go from an
NFL player to to a recreational athlete, right?
(05:13):
And it's pretty impressive that they can be knocked down that
far, but you lose your explosiveness.
And this has been a problem for a number of NFL players and it
happens outside of the NFL too. But this is a big deal.
And so that's what happens here now sometimes, which we'll talk
about in the potential surgical,you can see there there's
something called these little sesamoids.
They're tiny little bones that sit in the middle of this sort
of ligaments, these all these accessory ligaments and
(05:34):
everything else. Well, those can be injured too
with this. Now, again, it's like, it's like
we talked about a knee sprain, right?
It's not just a knee sprain. It may be an ACL, it might be a
meniscus, it might be cartilage damage, right?
The turf toe has various degrees.
You can get cartilage damage of the two joints just like you can
get cartilage damage to the knee.
And you can tear these the plantour plate and split these
(05:54):
sesamoids or you can tear the sesamoids or you can fracture
the sesamoids. And so there's various different
things that can happen with that.
Now we don't know exactly which one he got, but we know that Joe
Burrows is probably a high level1 given the fact.
That he had, yeah. Yeah, yeah.
Yep. So how, how do you grade it from
mild to severe? What are you looking for when
(06:14):
you're assessing that? When he comes over from the
sideline saying you know, I've got the discomfort, what are you
doing there? So the first thing you're doing
is you're, you're looking at this and you're trying to assess
like you basically are going to test that ligament out and
you're going to basically try toextend the toe, flex the toe
down and you're going to, I mean, you pretty much can
(06:36):
probably make some of your diagnosis there.
But really the key here is goingto be that MRI.
So to look and see whether or not it's the, you know, what
we're dealing with. And so that's.
Is there anything instantaneously like, you know,
obviously you, you tear your Achilles, you squeeze the calf.
If the foot just dangles and doesn't flex, then you know that
it's, you know, the Achilles haspopped.
(06:57):
Is there anything that you can see on the field right away or
is it something that is just a pain threshold and then you have
to get to an MRI? I mean, generally your NFL,
you're going straight to that. So, you know, that's a
combination of of both and for us to clarify for the players,
so the Joe Burrows underwent thesurgery just recently and Brock
(07:18):
pretty also got the injury. So actually we're talking about
two players here. So Burrows, it looks like he
went actually to the Andrews Institute, interestingly enough
to repair it, but I was under the impression he was going to
go to Bobby Anderson. So that's a that's an
interesting finding. But Bob may have flown down
there to help out because he's one of the Green Bay Packers
team doctors. So sorry, let's continue on.
(07:39):
So the so you're going to get the every all these players, all
these players are going to get Mris and they're going to get
them on the next day. I mean, when we were taking care
of the Giants, we would have Monday morning MRI review of all
the players that were injured during the week.
And then we'd go through them and say, OK, this is what it is.
This is what it is. So they've got the MRI the next
day. OK.
(08:00):
And then you don't think that's something, if they're at their
home stadium, that they could godo well at that point, they're
still kind of in the middle of the game.
They're not going to do it mid game probably because it just
doesn't make any sense to do it.It's not urgent enough to do
that and it wouldn't generally right.
It's always about like, what would the management do, right?
You get the X-ray, make sure they don't think broken.
If not broken then and they're good enough to play, then maybe
(08:23):
they put them back in. But if they're worried enough
for this situation, they're out for the game, right, And then
they're going to re evaluate on Monday in the facility because
it's kind of a standard practice, right?
You want your own radiologist tolook at it like a lot of these
teams, even if the let's say allthe radiologist, I mean, we know
a lot of these doctors, they're all great.
Like, you know, they as much as they like appreciate the team
position, taking a look at theirguys, they're like no, no, no,
(08:44):
no, we'll take care of it. This is our team.
They're very possessive of theirplayers, which is totally
acceptable. You just want to keep everything
in inside so they'll fly. I mean, we know this how this
works, but pretty much every time a player, when they finish
their game, even if it's 10:00 at night, they're hopping on the
private plane and they're flyingstraight home and they land at
4:00 AM and then again MRI at 8:00 AM.
(09:05):
So they're, they're always at home the next day.
Unless there's some sort of unforeseeable storm, they can't
make it. But it it they're getting this
MRI as soon as possible. All right, So explain the
severity difference between a Brock Purdy that they said, I
don't know between two and five weeks, which to me is that's a
pretty big range. When you say 2 to 5 compared to
(09:28):
a, you know, Joe Burrow, that possibly could be the season
that if they haven't already declared him out for the season
yet. I think he's out now because he
had just had the surgeries. I'd be shocked.
Maybe he'll get back, but we cantalk about ways that people are
accelerating those. OK, You know you have different
levels. You have grade 1-2 and three.
So you know the Grade 1 is just sort of a sprain.
Grade 2 is a sort of partial tear of the turf turf toe and
(09:52):
that's the mild turf toe injuries.
When you do kind of rest, you tape them anti inflammatories.
That's about a two to six weeks.So it's a pretty broad range.
When you get to severe, that's when we have them full rupture.
So he probably had a partial tear of his plantar plate and so
that's why he was in that small level.
But now they're finding out again, this is similar to many
of the injuries we're seeing that like sometimes when you
(10:13):
have these full tears, it's faster to fix them and more
reliable the player back out there more than a partial or
than just continuing to non opt them right.
Like we know that like some of these players that we'll talk
about later, it continually had non op treatment, non operative
treatment and they would push limp them along for weeks and
weeks and weeks and then re injure themselves the next year.
(10:34):
And now we're realizing with a lot of these things like, you
know, some of these players are the baseball players, it's like,
you know, they're just not throwing as well, like we should
just pull the trigger and do surgery.
So it's like we're we're learning more unfortunately, in
some cases that surgery sooner, as much as we want to be a
conservative culture that surgery sooner for this with a
fresh tissue or with these newertechniques like internal
(10:57):
bracing, which we'll get into. I know you love that word.
The we there's just we do need AT shirts.
So I mean with that, the there'sno reason why you wouldn't be
more aggressive with this. So mild turf tour is different.
But this planner play or sure, Imean, did you they with
Burroughs? They did.
He'd injured it in like a week later.
They said he's getting surgery, right.
So there wasn't even a question.Well, it was clear.
(11:18):
The MRI clearly indicated that this is yeah, we're done here.
This is not treatable because obviously with someone at his
level, one of the top three top five quarterbacks in the NFL,
you know that they would say no,there's just no recovery from
this. Let's go the route of Brock
Purdy. Let's say it's two to five
weeks, two to six weeks for thatrecovery.
(11:39):
I don't know if you could you fully recover when you know,
when you finally get back on thefield, you're planting, you're
stepping, you're planting, you're throwing, you're running
away from very large men. You know, people are landing on
you. I I don't, it is early in the
season, not Lake where it like happened with Patrick Mahomes,
where he's like, I'm almost at the finish line.
I'm just trying to gut it out. But you still have the whole
(12:01):
season. What what are the repercussions?
What are the what? What is Brock Purdy going to
have to go through for this season?
I mean, it's it's if he gets back too early, he could chance
to re rupture, right? And then he's going to get
surgery on it. The other thing is like, does he
just play, you know, basically with a, with a lack of push off,
right? Is there some sort of he's going
to have some sort of bracing on for a while, even when he gets
(12:24):
back? They're just not going to let
him go full boat unless he's completely pain free.
Maybe an MRI shows he's completely healed.
Remember, the Mris are always good.
On a toe, where does a brace go?Is is it a shoe?
Is it a ankle stability? What?
What do you? Mean it depends on the depends
on the injury. But in these cases, you know,
they have sometimes they have these like extended foot toe
things. So it's like a it's like a it,
(12:45):
it's like a basically like a sole of the shoe, but as an
extended toe plate, like a metaltoe plate.
He might have on there probably wouldn't be able to play with
that. But you know, these guys have
like master orthotics, right? So there's someone in there like
molding these custom things and they're like, OK, let's try
this. Boom, that doesn't work.
Go to the next one. I mean, it's unlimited supply of
cashier. So they can try all these
(13:05):
different things for him and they're going to do literally
everything to get this toe. They're going to use all these
sort of fancy gadgets that we probably haven't even heard
about yet. So I mean, it's going to be
they're going to try everything they can to get him, to get him
back. So rest immobilizing, taping 3D
(13:26):
models of somebody mad scientist, Doctor Frankenstein,
trying to create something that will fit his foot and and in a
kind of a way you go. Next question is why is this
called turf toe? Why don't we have like a cooler
name? Like, you know, when you hear
rupture or you know, tendon, youknow, or you know, ACL knee,
(13:47):
blown turf toe. Can you come up with a creative
way to rename this and maybe we can kind of rebrand this and
take credit for it? What?
What? How would you go?
About that, I can't think of a good name for this because it's
it's, it usually happens in football players.
That's why they call it turf toe.
It's the it's a, it's because ithappens.
And maybe we could just all my discussion we talked about turf
versus grass, but maybe you know, grass toe doesn't sound
(14:09):
any better. So at least.
It's a turf toe. All right, all right.
We're going down to Rex Ryan tree right now with these toes.
We're done with the toes. Let's go with today's
technology, right? Deion Sanders went through this
in the 90s, right? He, he had severe, you know,
with the turf toe, you know, andsomething that lingered.
What are the differences betweenin the 90s when Deion was
(14:33):
suffering through turf toe and probably playing with it where
he probably shouldn't have, right?
You know, and especially with that man up, you know,
mentality, what are the difference from then to now that
you can explain to our audience?Yeah, so go back to that picture
before you can show the fan the new technology which we'll talk
about again, we've talked about this at nauseam, but that's one
(14:55):
more. So this is a picture go back
that's perfect of all the ways we use internal braces now and
this while these some of these things are a little newer, some
of these are a little bit older.This is older in like the last
few years. So they're talking about
internal bracing. Now, if you've been bunions, but
you know you have ankle fractures, you add internal
brace in there to help with the stabilization.
(15:15):
You're doing these sort of anklethe ankle instability talk about
ankle sprains and adding an internal brace.
But you can see there in the bottom left hand corner, there's
plantar Pate internal bracing. And so this is sort of one of
the additions. It's just like the UCL repair
with internal brace, right? Without that internal brace, UCL
repair is not a good surgery. Like very few people to success.
(15:37):
It was very it was very unsuccessful.
That's why for years it wasn't successful.
That's why ACL repairs we talkedabout now saving AC LS because
we add the internal brace. So this internal brace has been
a game changer for these more simple repairs or because in a
lot of cases the repairs sometimes suck like this, don't
do that well. And so now we have so many more
(15:57):
surgeries that we can repair. So we keep the person's native
tissue and avoid adding grass and tunnels and holes.
And that we can do this the moreif we can repair everybody, that
would be the best case scenario.If you can repair all ligaments
that ever got injured, that would be the Holy Grail.
And we're getting closer. We're not there yet.
And of course, there's chronic injuries, which are different
(16:17):
than acute injuries. But now they have this ability
to internally brace the planter plate.
And so as a result, they see that, they see him tear it.
They're like, we have this new surgery and maybe he'll get back
instead of the four to six months, maybe 3 months.
And so three months is not as bad, maybe 2 1/2 months, who
knows. I mean, they tried to get Aaron
(16:38):
Rodgers back again, it was The Jets, but they try to get him
back in 10 weeks after an Achilles rupture because he had
an internal brace as well. So the idea is that these guys
are going to start pushing the envelope on this because
remember in orthopedics, everything goes in like 6 weeks,
12 weeks, four to six months. It's just the way we deal with.
(17:04):
So you know, it's the it's a pretty we have these standard
metrics that aren't always perfectly scientific, right?
You know, you always you've always heard the word it's four
to six months. Like that's a very common
orthopedic term. Takes six weeks for the bone to
heal. Well, doesn't always heal in six
weeks. Sometimes it heals in four
weeks, sometimes it heals in eight weeks.
But we like that word. We like the six weeks, we like
(17:24):
the 12 weeks. We like the way the follow-ups
work. So the idea is that people are
going to keep pushing the envelope on a procedure like
this, But remember, there's other things that go on with
this procedure. So not only is he going to so go
to the two slides over, it's thebest image I could find it
without grossing out the audience and showing an actual
live surgery of this. So now this is not the actual
(17:44):
turf toe repair because this is the second, which is the other
toe. It's the toe next to the big
toe. But this is the same sort of
technique. So what what they do is this
that planter plate, you can see it's popped there in the bottom.
And that's so basically you go on over the Gray toe.
That's what that's how you fix this.
Yeah, yeah. And they were threading the
suture through and then they do this very complicated repair
(18:04):
technique. And then you anchor it on the
other side in the, in addition to that, you add something
called the internal brace. So you add this synthetic
suture, this thick fiber tape and you anchor that on both
sides as well. Obviously there's a little,
there's a little bit room, there's very few room for air.
You can see how small this is, right?
So you really want to make sure you're accurate.
But there's sort of kits and things like that, that that
(18:26):
Arthrax has to help with this aswell.
So that's the that's the first part.
Another part is, you know, adding some sort of PRP or
biologic sometimes can help. We've talked about the
fertilized ACL. We literally just had Chad
Levender on here. I'm having that conversation.
So that's important. And then as you see between
those toes, there's cartilage. And so sometimes that cartilage
(18:47):
is damaged. And so that may be something
that we want to additionally do because if you don't take care
of the cartilage damage and he has it there, it could go on to
being painful. So now you have lost power or
let's say your plantar plate heals great, but now you still
have pain cause the toe has arthritis in between it.
And that's a big problem. And we talked about this a long
time ago, I think it was Serena Williams had this and she had to
have a fusion. So it's not ideal to have
(19:09):
cartilage damage there. So all those things.
And then the last one, which again, little simple injury,
that's so jastic. The sesamoid bones, those little
tiny hole bones that I showed you on the previous thing, if
those are fractured, they can sometimes fix them or take them
out, which is uncommon. But the other thing is they can
tie all this in because those sesamoids live inside of that
plantar plate area with the ligaments.
(19:32):
Those little bones live in there.
You see how they're all connected together, right?
When you do the when you do the dissection doesn't look like
this. I wish it did.
That'd be amazing. Every surgery would be amazing
if it always looked like the picture, right?
But we know that's not real life.
So anyhow, so so the idea is yourepair it all together.
So that's what they did for Joe Burrows.
And I have a feeling that he'll be back faster.
(19:53):
But again, it just depends too about, you know, that the
Bengals don't do well. Like why race him back?
You know, if they're doing really well, maybe they change
their mind on when he comes back.
It's really tricky. I think that's the hardest part
of some of these recoveries is you don't really know what the
true return to sport is for thisplayer because let's say
they're. Let's say now it's September, so
(20:13):
October, November, December, 3 months and they're not even
close to play offs. Why would they put them back in?
Yeah, I I agree. I agree.
You're never going to know. I mean, he could take him.
They're going to say he got backin five months, but he could
have gone back in three. It all depends on when they get
hurt. It's just like all this in
season stuff. Yeah, yeah.
And so think cleats help lead tothese type of injuries.
(20:37):
Is is that common or is this just the way it is, you know,
stressing that area pushing off all of a sudden that you
develop? Or is it maybe 300 LB people
landing on your foot? Yeah, You know, there's lots of
things on there. I'm.
Just wondering footwear as because foot the the cleat is
very different than anything else that we wear.
Yeah, I mean, this is this is a this may be AI mean the
(20:59):
challenge is on the bottom to protect it.
It's different than like ankle sprains, which we may have a
sneak peek at that later on in the next few weeks with some new
episodes being released. But I'm sure there's people that
are looking at it. I mean, anytime an injury
happens, we've looked at the numbers.
It's extremely expensive. I think I texted you recently
that the number we had wasn't even close to what they're
seeing now. They're like talking about in
(21:19):
the in the billions of dollars lost for these players because
it's so much money. What about training?
Is there anything that you can do?
You know, I'm reaching over herewith the bottom of your foot
trying to see if there's anything that you can do.
Is it training? Is it strength?
Is it, is it flexibility? Is it stretching?
I know that there's been these contraptions that you put over
(21:42):
your foot and you can pull, you know, you're doing anything with
band work to just kind of keep that flexion going on in that
area. I'm just curious for what you've
learned and spoken with your colleagues.
Is there anything that says if you do this, you lower the risk
by, you know, 3% or something like that?
So this is a great point. I don't want to belabor this on
(22:03):
the show because it's a lot, butthere is this small sub faction,
people that have started talkingabout prophylactic surgeries,
prophylactic internal bracing. So in these people that are
really high risk, is adding likean internal brace ahead of time
where there's really no recovery, right?
You just anchor it and you just let them go back.
(22:24):
You let the incision heal. Would that protect someone from
having a turf toe? Not in this case, but they talk
about it for ACL tears. Or do you add like a second
ligament back it up so you can prevent the ACL?
I mean, it's a little crazy right now, but the idea of
preventing them, I mean, let's say you kind of knew you're like
this. These, these six players are at
high risk from AI algorithms, right?
(22:46):
What we talked about before, AI in medicine.
So let's say you have an AI algorithm and it shows that like
you, these are your top 2% of players that are at risk of
getting this and you're out for four months or lingers, You're
never the same, right? I mean, some people might
consider it. Or do we do a minimally invasive
thing where you just do 2 micro incisions, you throw the tape
underneath, you avoid the tendons, you do it all under
(23:08):
ultrasound guidance and you can do it in the players back in two
weeks, right? Like we may get there at some
point. So this is this is something to
be considered because if nothingelse is torn, then it's again,
I'm not advocating for surgery that's not indicated or surgery
before someone gets hurt. But but it the concept's pretty
crazy because what was if we allof a sudden didn't and saw that
(23:30):
no one got turf toed for like anentire season?
Yeah. You know, maybe we don't know
that's. Maybe we get to the point where
it's not permanent that you plant something in just for the
season and then you remove it. Or do we have biologics, right?
You start having soreness, you see that you throw biologics in
there. I mean, that's probably where
we're going, 'cause that's the easiest sell to these NFL
(23:52):
athletes is like, hey, you know,like, oh, your toes turning in
the season MRI shows is a small partial tear.
Let's just pump you with a little bit of some PRP or bone
marrow or other stem cell options and then you know, you
heal then you're good. It scars in we got a new MRI.
It looks good. So you know that we're we're not
there yet, but it's there's morethings down the pipeline and
there's things we're not even talking about on the people
(24:14):
we're working on. So.
Yeah. And we're talking about a
billion gazillion dollar industry where the quarterback
position is by far the most valuable position no matter what
anyone says. Well, it's the pass rusher, the
running back, the why receive it?
No, your team cannot function without a a high level
quarterback, as we've seen for the last decade with the New
(24:35):
York Giants. And he didn't even have Turfto.
And he did David have Turfto. This is a this is a great topic.
We're going to have a lot of other topics to follow.
We always want to let everybody know.
Check us out at sports.talk.com for more episodes, transcripts.
And we've had some very welcoming, curious and talented
(24:58):
requests to be on the show. So but keep it coming.
We, we love it. We love to talk to you.
We love that you reach out. So we really appreciate it.
Doctor Garcia, you got anything to put a ball on this or
internal brace on this? Internal brace exactly.
That's right. So I know well, thanks for
listening and yeah, keep the request coming.
We get a lot of requests. So it's it's nice.
(25:19):
It's just again, we want to stayfocused on the sports talk, talk
and you know, all orthopedics, all sports all the time.
So that's our we try to keep that focus for our for our
viewers. All right.
Thank you very much, Doctor Garcia.
Take care.
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