Orthopedic surgeons said the stress fracture 49ers running back Carlos Hyde has dealt with the last 2 1/2 games likely is one of two varieties common to football players.
It’s either a small break on the outside of the foot – often referred to as a Jones fracture – or to one of the small bones in the midfoot. Both can heal on their own in someone as young and healthy as Hyde, 24, but usually only if the patient avoids stress on the foot for an extended period.
The 49ers have not divulged the nature of the injury, but Hyde told CBS sideline reporter Tracy Wolfson before Thursday’s game against the Seattle Seahawks that it was a stress fracture, then said, “Something like that,” when asked to confirm the diagnosis after the game.
Coach Jim Tomsula said Friday he would not discuss the specifics of Hyde’s injury or any other. But he said he was assured Hyde, perhaps the team’s best young player, does not risk turning a small fracture into a serious injury.
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“With our medical staff, we’re not going to put somebody in danger,” Tomsula said. “So I have complete confidence in that. Our people don’t put people on the field that are at risk to further injure themselves.”
The injury appeared to have happened midway through the third quarter of the 49ers’ Week 5 loss at the New York Giants. On first down, Hyde went out for a short pass. As the ball arrived, he took a hard step forward with his left foot on the artificial surface and lunged for the ball. At the same time, 236-pound linebacker J.T. Thomas jumped on Hyde’s back to try to break up the pass.
Hyde limped back to the huddle, could not bend properly for a pass on the ensuing play and removed himself from the game on third down.
UC Davis surgeon Eric Giza said stress fractures to the outside of the foot, or fifth metatarsal, are common among athletes, including football players. He said the usual process is to undergo surgery immediately, have a screw inserted, then rehabilitate and return to the field.
“I’m a little surprised they’re not being more aggressive,” said Giza, chief of the UC Davis orthopedics department’s foot and ankle service and team physician for Republic FC. “But it could be another variant.”
Another type of fracture can occur to one of the small bones in the midfoot. Dan Solomon, an orthopedic surgeon with Marin Orthopedics and Sports Medicine in Novato, said that kind of injury could come from a single impact, especially when the foot is bearing more weight that normal.
Solomon said a mid-foot fracture typically will heal on its own in young, healthy patients, especially if it is not displaced – Hyde’s fracture almost certainly is not displaced – and if the patient rests the foot.
That’s not the plan with Hyde, who continued to play against the Giants and started the next two games.
During the week, the 49ers mostly keep him off the foot by putting him on an exercise bike while the rest of the team practices. He’s also wearing an orthotic designed to reduce stress at the spot of the fracture.
Offensive coordinator Geep Chryst said the 49ers might follow that plan the rest of the season. Chryst likened the protocol to one the Carolina Panthers used when hard-charging running back Jonathan Stewart dealt with a foot injury in 2009.
“ ... He didn’t do a whole lot during the week and then played great on Sundays,” Chryst said of Stewart. “So I would expect the same out of Carlos. That’s what Carlos wants to do.”
The orthopedists said even the smallest fractures can worsen if the stress continues and at some point surgery becomes necessary. Until then, it’s a question of pain tolerance.
Hyde returned to the Giants game and picked up 46 of his 93 rushing yards in the fourth quarter, suggesting his hard-running habits have not been drastically altered by the injury.
But he clearly has been in pain, including on one play the following week against the Baltimore Ravens when he took a handoff, planted his foot and suddenly dropped to the ground in agony.
“It just shocked me how bad it hurt when I tried to put too much weight on it, and I just went down,” he said.