By Fred Cushner, M.D.
New York Knicks Team Physician

George Lynch made his return to the Philadelphia 76ers lineup after suffering a fracture of the fifth metatarsal bone in his left foot. NBA.com recently talked to New York Knicks team physician, Dr. Fred Cushner, about this type of injury.

The fractured bone we are talking about is the metatarsal bone, and there is one metatarsal bone for each toe. In Laymen's terms, it would mean the pinky toe.

The bone is located at the base of the toe, rather than the top towards the toenail. In fact, you can actually take off the shoe and feel it because the bone is very prominent at the bottom of the foot right below the heel bone.

This area is very prone to injury, and there are actually two different types of fractures that can occur in this area. One is called a dancer's fracture, which is similar to a bad sprained ankle where the tendons pull a little piece of the bone off. That's much less serious. Some people just put it in a soft dressing or a cast for a couple weeks, depending on the patient's pain, but that heals up fairly uneventfully.

Lynch returned to the Sixers lineup Wednesday and tallied two rebounds and two steals in eight minutes. NBAE Photos

The one that basketball players usually suffer is called a Jones fracture. This injury is a little bit higher up and can be a more troublesome type of injury. This is the type of injury George Lynch suffered. If you were not going to treat it with an operation, you would have to put him in a cast and not let the patient put weight on the foot for six weeks. Basketball players often have flat feet or feet that roll in when put a lot of pressure on this area often they could get a stress fracture or trauma in this region and often they don't heal.

For that reason, we would rather treat the patient by putting the foot in a cast without bearing weight and run the risk of it not healing or recurring when they return to sport a surgical operation is performed. That's what Lynch had on May 13.

This fracture occurs in an area where there is a junction of good blood supply to a junction where the blood supply is not as good and that's what presents all the problems. That is why this injury is treated so aggressively with the screw.

The operation itself is just a small incision into the base of the toe and a screw is run between the top and the bottom parts of the fracture. It gives a good squeeze to the area. You use as big a screw possible and you get good compression at the fracture site and the result is that the screw stabilizes the fracture. The way it stabilizes is like a steel reinforcement because you have the screw going through the two ends of the bones. The screw also provides compression at the fracture site. Both are extremely important.

Now the question is, if the operation was done on May 13, has it healed? Well, it's healed some but it hasn't healed completely. And there are different types of healing. Radiographic healing may not happen for three or four months. That would mean that when you look at the x-ray you couldn't see the fracture line. Another part of the healing process is how symptomatic the patient is. Certainly the fracture does not totally heal in a month, but there is some scar cartilage and that slowly turns into bone. The pin is supporting the fracture as well.

And certainly a decision was made because it is the Finals and he wants to play.

The obvious question now is there a risk to playing? Certainly there is a risk. You can not play on a fracture that is not united and not have some risk but the main thing would be how high is the risk? The screw protects the fracture, and the trainers will certainly try to minimize that risk. They will tape the foot and help protect the fractured area as best as possible. The trainer will be working closely with the player to decrease movement in the area and support the ankle so he doesn't roll it and put pressure on the area.