Burrow was injured halfway through the second quarter of yesterday’s contest and never returned despite receiving treatment throughout the game. He was eventually classified with a turf toe injury, and images of the injury were sent to renowned foot specialist Dr. Robert Anderson. Upon review, the recommendation was that Burrow undergo surgery to address the toe, which likely sidelines him about three months.

Turf Toe – The Injury That Is Worse Than It Sounds

The term “turf toe” doesn’t sound like all that significant of an injury, which is why many people are wondering how the injury is sidelining Burrow for the majority of the regular season. Despite the moniker, the injury is actually quite painful. A turf toe injury occurs when your big toe is hyper-extended, often when the toe remains on the ground while the heel is lifted and a significant stress or twisting force is placed on the foot. This action leads to damage to the soft tissues that support and stabilize your big toe joint.

Turf Toe injuries tend to come in one of three different grades:

Grade 1 – Mild to moderate overstretching of the soft tissues of the metatarsophalangeal joint of the big toe. Presents with mild discomfort, but can be overcome in a matter of a few days to a week with the help of conservative care.

Grade 2 – Partial tears of the supporting soft tissues are present. Pain is more intense and walking will be uncomfortable. Oftentimes it can be managed without surgery by pursuing conservative care for a couple of weeks and a gradual reintroduction to stressful activity.

Grade 3 – Complete tear of soft tissues and ligaments of the big toe joint. Surgery is required to reattach the torn ligaments and stabilize the joint. Full recovery takes about three months after surgery.

Based on the reports out of Cincinnati, it seems likely that Burrow suffered a Grade 3 injury with complete tearing of key ligaments in his toe. In order to give the ligaments the best chance to make the strongest recovery, surgery is necessary. It’s not the news that Bengals fans or Burrow wanted to hear, but it shouldn’t be a long-term problem assuming the surgery is a success and he commits to a post-op recovery program.

The Bengals are 2-0, and while they’ll have an uphill battle to stay ahead of the Baltimore Ravens in the AFC North, it’s conceivable that Burrow could return late in the season if the Bengals can remain in playoff contention. It’s not a death blow for the Bengals, and if they can stay in the running for the playoffs, it’s certainly possible that Burrow could be back on the field for the end of the regular season or a postseason run. We wish him all the best in his surgery and recovery efforts.

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The injury looked quite painful in real time, as Burrow’s leg twisted, buckled and crumpled awkwardly as he was sacked early in the third quarter. He was in obvious pain on the field while being tended to by trainers, and he was eventually carted off the field. You can see video of the injury below, and while it’s not as bad as Joe Theismann’s injury, it’s not a great watch if you’re squeamish.

This Joe Burrow injury is brutal. It pops out and then back in. pic.twitter.com/AMWVZvgIud

— Joseph Cecena (@joe2strong) November 22, 2020

Burrow will undergo an MRI later today to determine the full extent of the injury, but it’s already been reported that he’s suffered an ACL tear and that there may be additional damage. Burrow himself seemed to confirm the severity of his injury and that he’s out for the remainder of the year, as he tweeted Sunday night, “Thanks for all the love. Can’t get rid of me that easy. See ya next year.”

Dr. Silverman Comments

Ouch, that look like it hurt.

We’ll know more about the extent of his injury after the MRI results come in, but we can take some educated guesses about what happened to his knee based on the mechanisms involved and our experience with these types of injuries.

This is a valgus injury with axial load, which results in the knee buckling inward. Depending on the axis of rotation, these forces can typically lead to ACL tears, MCL tears and even a tibial plateau fracture. Let’s take a closer look at both potential injuries:

ACL/MCL Tears – An ACL and MCL tear involves a very long recovery. The injury is well understood and can be carefully managed. It does tend to have good results when addressed surgically, but it’s important to remember that it doesn’t always return the player to their pre-existing level of ability. Now, Burrow isn’t a super mobile quarterback, but it’s not solely about mobility and function, it’s also about his confidence in his knee. If he’s hesitant or protective of that knee going forward, it could impact his game. He needs to work to recover both physically and mentally from this injury.

Tibial Plateau Fracture – This involves a fracture in the upper portion of the tibia, the uppermost bone that connects to the knee. These fractures can come in many different forms, like displaced, non-displaced, transverse or comminuted. Even when treated successfully, this type of injury can lead to long term flexibility loss and arthritis. The fact that a fracture hasn’t yet been confirmed is good news, but this injury tends to occur in conjunction with ligament and nerve damage, so it’s not out of the realm of possibility that he also suffered a tibial fracture alongside the suspected ACL tear.

Burrow is clearly out for the year, but we’ll want to keep tabs on the official MRI results. The fact that he is young and strong will help him in his rehab, but this type of injury isn’t guaranteed to fully resolve just with time and physical therapy. He’ll need a little bit of luck on his side to regain full strength and confidence in his knee. Good luck Joey B, we’re rooting for you.

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