Watkins, the 24-year-old wide receiver drafted with the 4th pick in the first round out of Clemson in the 2014 NFL draft, struggled last year after posting a fantastic 2015 season for the Buffalo Bills. After posting over 1000 yards with 9 receiving touchdowns over 13 games in 2015, in 2016 Watkins only managed to play in 8 games due to a re-injury to his left foot. He mustered 430 receiving yards and only 2 touchdowns.

Coming into the 2016 season we knew that Watkins had recently just had completed his rehab from the notorious Jones fracture of his left foot, which he had surgically repaired early in 2016. A Jones fracture is a very significant injury, and is notorious for delaying and destroying the careers of many athletes, including Julio Jones, Marvin Jones, Kevin Durant, and Yao Ming to name a few. As you can tell by some of the names on this short list, athletes who suffer this fracture can go on to very productive careers, while others unfortunately succumb to the injury and never reach their potential.

The Jones fracture is named after Sir Robert Jones, who described the initial injury in 1902 as a fracture located exactly 2 centimeters from the base of the fifth metatarsal (toe). This is a very specific location, and just a mere few centimeters in either direction change the progress and outcome significantly (better). In total, there are three different fracture-types for the fifth metatarsal, and these can be distinguished from one another by mechanism of injury, location, treatment options and outcome. A Jones fracture is the worst of the three, and is located more proximally; located at the level of the entire for fourth-fifth intermetatarsal articulation, more commonly known as Zone 2. Click below to learn more about Jones fractures:

Jones Fractures

What is the most common cause of a Jones fracture?

The most common causes of a Jones fracture are the result of an acute plantar flexion/inversion injury, or a medially directed force on a planted foot, thereby creating an acute fracture. There may be a history of what are known as prodromal symptoms, which may suggest that the fracture occurred in an already stress fractured bone. One study demonstrated that with the fifth metatarsal fractures, nearly 45% of the patients reported pain on the lateral side of the foot prior to the acute fracture.

How is a Jones fracture treated?

Jones fractures can be treated one of two ways, either operatively or non-operatively. About 25 years ago, nearly all Jones fractures were managed non-operatively, with 6 to 8 weeks of non-weight-bearing. However since then, there has been compelling evidence that surgical placement of a screw has superior outcomes, both in faster return to play, in as early as 2-4 weeks, as well as fewer recurrences compared to the non-operative (cast) treatment. The average time to return to play following a primary screw fixation is approximately 7.5 weeks.

Why are a Jones fracture such a big deal and so much different than a ‘regular’ fracture of a toe?

The main reason why Jones fractures are so difficult to treat and have a such a difficult time healing, is because the blood flow and nutrient supply to the bone area is so poor. What can happen is what is known as a non-union injury, where there is insufficient blood flow to heal the fractured bone appropriately, leading to poor healing of the fracture site – unfortunately even if a screw is implanted. This is one of the few areas in the body that we called ‘watershed’ areas, which suffer from very poor blood supply and have difficulty healing. Because of this, re- fractures are unfortunately quite common, despite the placement of a screw, and re-injury often occurs soon after the athlete returns to play.

If a person suffers a re-fracture and nonunion injury, the best treatment is often with the implantation of a larger screw accompanied by bone grafting. The average return to sport for a re-fracture and non-union injury is about 12 weeks. My suspicion is that this is what Watkins needed to have done this offseason. This injury is notorious for re-injury risk, especially if the athlete returns to sport too quickly. Most physicians typically wait for fall radiographic healing before returning to sport.

How Watkins’ foot injury derailed his 2016 season

It is known that Watkins first underwent surgery for a Jones fracture in spring of 2016, presumably for a screw insertion. This injury may be the culprit for Watkins’ is poor 2016 season. Unfortunately it seemed like Watkins re-fractured his foot pretty early in the season (he missed weeks 3 through 11) and rather than end his season early to have another surgery, he struggled with foot pain while trying to play through it.

Throughout the majority of the season Watkins was day-to-day with foot pain, causing him to miss several practices. Missing these practices every week lead to limited reps and difficulty developing a rapport with Tyrod Taylor. We know that Watkins is explosive when healthy and on the field as pointed out by his monstrous 2015 season. However, when Watkins is injured, he is a shell of his former self, which goes to show how debilitating a Jones fracture can be to an athlete – especially a wide receiver.

Watkins underwent his 2nd foot surgery on his Jones fracture in January, and although there is limited information, one can assume that he had a larger screw placed along with bone grafting. As mentioned earlier, the average time to return to sport after a second Jones fracture surgery is about 12 weeks. So the good news is that Watkins had returned to practice by the first week of June, and took part in the team drills. Unfortunately for Watkins, the Buffalo Bills did not pick up his 5th year team option for 2018, hopefully resulting in a ‘prove it’ year for him, which may help to motivate Watkins more this upcoming season.

What are expectations for Watkins this upcoming season?

Unfortunately in light his recurrent foot injuries, I have reservations about how good Watkins can be this season. Despite his young age and loads of potential, I am very concerned about Watkins re-injuring his left foot for a 3rd time. The poor blood supply in this bone leads to a high risk of re-fracture, especially if he continues to do the same activities that caused the injury in the first place.

If Watkins can stay healthy he has the potential to be a top 10-wide receiver, but that’s a big IF. I feel like Watkins has the potential to either repeat his monstrous 2015 season (assuming he stays healthy) or he suffers a similar fate to the 2016 season, where he was injured more than he was healthy. Personally I may consider drafting him as a WR3-4 only if he falls to me, and just hope that he stays healthy. Do not be the person who overreaches for him though; instead be smarter with your picks, and let someone else make that mistake. Watkins is currently being drafted as the 16th WR in 12-team non PPR leagues, and 19th in a 12-team PPR leagues.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Board-Certified Family Medicine physician, and I am currently completing a Sports Medicine Fellowship at the University of South Florida in Tampa. If you have any questions or comments, you can contact me directly at @DrJesseMorse or visit my website at: www.DrJesseMorse.com. Keep an eye out for my next article!