It was early December, and the 49ers were rolling on both sides of the ball until 1 bad sack shook up the offense and several QB careers. Jimmy Garoppolo suffered a fractured left foot injury on Sunday, December 4th against the Dolphins.
While this opened the door for Brock Purdy and gave new life to Trey Lance, Jimmy’s timeline got lost among other headlines. Now that he’s in Las Vegas, Raiders fans are left wondering what comes next and what is a cuneiform?
More: Javonte Williams Injury Update
Jimmy Garoppolo Injury Video
Jimmy’s foot injury occurred in week 13 during the first drive. Miami Dolphin OLB Jaelan Phillips got the sack which resulted in Jimmy landing with a foot that rolled out.
According to post-game interviews he had several fractures, and they were concerned about a dreaded Lisfranc fracture.
False Alarm: The Lisfranc Fracture
A Lisfranc fracture is not necessarily broken bones but is closer to a dislocation. The toe bones (metatarsals) can get displaced from the foot bones with a twist or with a fall onto a flexed foot. Breaks, or fractures, can occur but are not necessary for this diagnosis.
This is referred to as a fracture because of historical reference more than technical accuracy. This dislocation almost always requires surgery to stabilize and allow for proper foot mechanics.
On Jan 7th, the 49ers reported that Jimmy Garoppolo’s Injury was not a Lisfranc fracture and would not require surgery. This most likely means he fractured 2 or more metatarsals or foot bones without displacement.
The recovery for most bone healing is 6 weeks. At the time, Jimmy had to be looking ahead to the Super Bowl as with all the other 49ers. He “recovered” in the standard 6 weeks it usually takes and was in fact cleared to practice the week of the Divisional Round. He would be ready to play in the Super Bowl, had it panned out that way.
Unfortunately, the team’s season ended one game short, and Jimmy was a free agent with a banged-up foot in the middle of a healing process.
What Injury Did Jimmy Garoppolo Get?
Cuneiform
There are three cuneiform bones. They are a solid complex that makes the arch of the foot and helps make a rigid lever to aid in propulsion. The Medial and Intermediate cuneiform bones are the foot bones that connect to the 2nd metatarsal. They are on the inside of the foot.
The interesting thing about Jimmy Garoppolo’s Injury is that these fractures are rare. In fact, there isn’t enough data to calculate their rate of occurrence in athletics. They’re most often seen in vehicle accidents – especially motorcycle accidents. Think of where your foot sits on the foot pegs.
There are some reports of horseback riding due to stirrups, and occasional injuries in hockey players who block a slap shot with their foot. Most of these fractures do not show up well on X-Rays. They are small, cube-shaped bones that are tightly packed by other bones.
More: Best NFL Bets For This Season
There isn’t much room for the fractures to move apart, look strange, or even give a clear view on the imaging. But they are caught on CT or MRI.
The primary issue with Jimmy Garoppolo’s Injury is that it is a complex, multi-joint injury. Each cuneiform bone articulates (touches) the metatarsals, and the cuneiforms articulate with each other. Together they help form the arch of the foot and provide subtle gliding movements to allow walking, running, and even throwing a football.
Little Bones, Big Impact
For complex fractured cuneiforms, the outcomes tend to be poor. It can heal to be structurally sound, but it often comes with chronic pain, discomfort, and early arthritis. If even one of these bones is not moving in sync then each step can cause pain. Also, an injury like Jimmy Garoppolo’s results in damage to the cartilage that surrounds the bone which places more force on the actual bone.
Now here’s the tricky part. The Anterior Tibialis muscle, which allows the foot to be pulled towards your body (dorsiflexion), attaches to the medial cuneiform. Every time the foot is pulled up, there is potential to tweak the injured area. This muscle also has a role in correcting the foot if the ankle is rolled excessively. Any ankle injury could now affect this boney complex.
The Big Stir: Addendum G
As soon as free agency opened, teams seemed to not be concerned with Jimmy Garoppolo’s Injury due to the fact that he signed a 3-year contract worth $72.5 million with Las Vegas Raiders.
But then Addendum G was discovered.
Then, the contract was restructured so that the signing bonus was removed and added to the base salary. Finally, Addendum G was added to the contract which stated he could be cut if he cannot pass the physical, cannot play at least 1 regular season game, or suffers another injury to the left midfoot then the two parties can walk away from the deal.
The Media Frenzy
The media freaked out about this clause and Jimmy Garoppolo’s Injury for about 2 weeks but they didn’t connect any of the actual anatomy or injury to the reasons for changing the contract. The waiver states that he has a pre-existing condition from fractures of the 2nd metatarsal and two cuneiform bones (medial and intermediate). The 2nd metatarsal is the toe bone to your second toe.
Jimmy G Surgery
After signing with Las Vegas in March, Jimmy had a procedure described as a clean-up. It would make sense if they needed to clean out a bone fragment or some scar tissue that was rubbing or pinching in this densely packed area.
More: Breece Hall’s Injury And Fantasy Outlook
This recovery is typically 6 weeks of healing with PT of the foot and lower leg muscles. The other option is that they address the Anterior Tibialis muscle insertion. Recovery would be closer to 12 weeks. Either way, Jimmy should be ready for team camp in late July. He might even be seen throwing a little bit in late June.
Jimmy Garoppolo’s Future As A Raider
The positive is that this looks like a situation where Jimmy G will recover successfully from this injury and be the starter at the beginning of the season. All of his limitations will be quickly revealed. The season starts with Denver, Buffalo, Pittsburgh, and LA Chargers who should all be strong in the pass rush.
I mean, the poor guy has to test his foot against Gregory, Von Miller, Watt, and Bosa. Even though he is likely the best-rostered QB due to experience, he might be led to slaughter if he can’t escape the pocket. Not being able to stretch the secondary or scramble kills the offense.
Props to Jimmy Garoppolo for fighting through pain and injury, but at the end of the day results matter and he may need to move to a mentor role before mid-season.
Las Vegas should have a solid offensive line and potent weapons all around this year. But he will likely be limited in scrambling and throwing deep. I know you’re going to say he was already limited on the deep balls.
But the negative is the fact that it’s his left foot, which is his lead foot for throwing, which means he’ll have to step hard onto the injury to actually launch it downfield. That’s not a great combination especially for an offense that liked, or sometimes needed, to bomb it to Adams.
Garoppolo’s Fantasy Outlook
Fantasy-wise, I doubt anyone planned on drafting Jimmy G as their starting QB. But I bet he feeds his check-downs early and often. Josh Jacobs, Michael Mayer, and Hunter Renfrow should benefit in PPR. Davante Adams will still get his but might not be in that elite tier until a more able body is under center.
I would also keep an eye on Aiden O’Connell. He probably won’t need to be drafted unless it’s a 2 QB or a 14+ team league. But if you’re desperate for a QB late in the season or due to injuries, he has a high chance of starting later in the year.