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Ten-Point Stance: Schaub's foot forecast remains cloudy

by | CBSSports.com National NFL Insider

Schaub's foot injury is one of the most tricky to diagnose. (Getty Images)  
Schaub's foot injury is one of the most tricky to diagnose. (Getty Images)  

1. Houston quarterback Matt Schaub did a radio interview on Tuesday in which he sounded like someone had stolen his milkshake. It was understandable. His season is likely over. We'd all be angry, too.

In that interview with 610-AM in Houston, Schaub said something very curious.

"It's not career-ending, no way," said Shaub, who injured the joint in his right foot. "I'd like to talk to whoever is out there reporting rumors or spreading rumors because those people pretty much have no idea what they are talking about. There's a ton of football ahead for me and the Houston Texans."

Actually, no one said the injury was career-threatening. And it's probably not.

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Probably not.

The reason I reported this week it was season-ending is because the type of injury Schaub has is an extremely tricky one that, even in the best of circumstances, can take a great deal of time to heal.

Dr. Benjamin Wedro, an expert who practices emergency medicine, wrote this in his blog about the Schaub injury, a likely LisFranc injury: "Schaub sustained a Lisfranc injury of the metatarsal tarsal joints of the midfoot. A quick anatomy lesson: the metatarsals are the long thin bones that connect each toe to the midfoot, where the tarsal bones are located ... this joint is put under great stress when the foot flexes down as the body falls forward [...] think of stepping into a hole falling forward. In football, the injury occurs when the foot is pointing downwards and somebody falls onto the heel."

Wedro next wrote something very important: "Lisfranc fractures can be subtle and hard to diagnose. Often the patient can't remember the exact mechanism of injury but knows that walking is either very difficult or impossible because of the pain. [A] physical exam shows swelling on the top of the foot and pain with foot movement. X-rays are important to do but they are often difficult to interpret. The fracture may not be recognized on initial reading. More importantly, there can be subtle changes in alignment of the metatarsal and the tarsal bones at the joint that may be missed.

"Some studies suggest that only 60 [percent] of fractures are accurately diagnosed. This is important because missing this injury and failing to repair it can lead to arthritis in the joint and chronic pain. It's important to remember that the foot absorbs the force and shock of every footstep, and solid architecture and anatomy [are] needed for the foot to do its job. [A] CT scan of the foot may be needed to get accurate images and make a firm diagnosis."

This is why Schaub is getting more expert opinions, just in case the initial ones are wrong. Team doctors do make mistakes, but they are some of the best in the world. It's unlikely the Texans doctors are wrong.

These two nuggets from Wedro were informative. First, even in a best-case scenario, patients with this type of injury are in a non-weight-bearing cast for at least six weeks. Second, even with the best of care, which Schaub will receive, arthritis and chronic pain can be a complication in 25 percent of patients.

Then came the important question. I asked Wedro whether this type of injury can be career-threatening. His email to me was interesting.

"The short answer is yes," he wrote. "The fracture dislocation may not heal well and [may] cause a significant amount of pain due to instability or arthritis in the joints of the midfoot. However, elite athletes have been known to overcome significant pain after injury and continue their career."

So, despite Schaub's protestations to rumors that didn't exist, there is a small chance this injury is career-threatening. It is indeed possible.

"He is being seen by numerous specialists and that could mean a couple of things," Wedro told me. "Either he needs surgery and wants a second opinion as to the type, or there is a possibility that the bones are appropriately aligned and may be treated conservatively without surgery and more than one opinion is wanted to confirm the alignment and stability. Unfortunately, good surgical results as defined by proper alignment and healing on X-ray does not necessarily correlate with a good clinical outcome with pain control and full range of motion of the foot."

Translation: how much pain Schaub can take will be a huge factor in how this injury affects his career. Range-of-motion issues could also be a factor. Now, Schaub isn't a running back, but range-of-motion problems could affect his drops and his scrambling.

Bottom line: the probability of Schaub missing this season is extremely high, and while he'll likely recover just fine, there is a chance -- a chance -- this injury could mean more trouble in the future.

2. The Philadelphia Eagles are finally seeing what I've been saying for years. DeSean Jackson can't be fully trusted.

3. There was a time that could also be said of the Giants' Brandon Jacobs (and maybe still can be), but in the last few weeks, I'm told, Jacobs has been very professional. No, no one expects that to last.

4. One more thing on the Giants: the defense has at least one takeaway in 22 straight games, the NFL's longest active streak. I think they have the best chance of beating Green Bay. If the Packers beat them, the Packers are going 16-0. At the very least.

5a. Champ of the week: Patricia Traina. Or, dudette of the week. Allow me a personal aside. Traina has been reporting on the New York Giants for years and does excellent work. She currently writes for Inside Football and TSX. More importantly, she recently beat cancer. She's one of the more inspirational stories from this football season.

5b. Chump of the week: DeSean Jackson. Pay him big money at your own peril.

5c. Tweet of the week: New Orleans quarterback Drew Brees: "Your limits are set by your own perceptions."

6. One last thing on the Texans. Anyone who believes Matt Leinart will lead the Texans to a Super Bowl post-Schaub hasn't seen him play. He is easily one of the worst quarterbacks I've seen in the last three years or so in the NFL. He is painfully inaccurate, has no pocket presence, very little arm strength and isn't a leader. Other than that, he'll be just fine.

7. The Jets defense is going to annihilate Tim Tebow this week.

8. The most frustrating team in football isn't the Eagles. It's Baltimore. In speaking to people around the league, they can't identify why the Ravens can beat the hell out of the Pittsburgh Steelers one week and then lose to the sorry Seattle Seahawks the next. When personnel men around the league examine tape of the Ravens, nothing jumps out (the lack of carries for Ray Rice in some situations not withstanding). I'm told people inside the Ravens organization are equally dumbfounded. No one has answers.

9. Some NFL players are having a serious case of lockout flashbacks as they watch the NBA season go through its labor pains.

10. I'm told various people representing Penn State have begun reaching out to high-level NFL assistant coaches to see if they'd be interested in the head coaching job. Who is making the calls on behalf of Penn State? I'm not sure but I am sure of the response the school has been getting. The response so far has been: not interested. The feeling among the coaches is that the job will be a mess for at least several years and few have a real shot to win there anytime soon. The people making the contact with the assistants are asking the assistants to stay quiet out of fear a coaching search might seem inappropriate at this time.


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