Big news came out about Josh Allen following the January 29th press conference to announce Joe Brady as the newest head coach of the Buffalo Bills. Allen took the stage following Brady’s announcement and revealed that he had undergone surgery on his right foot. He went on to say that this was to remove a bone chip in his foot, specifically a fifth-metatarsal avulsion fracture.
This was a known possibility last week after Brandon Beane had announced that Allen might need a procedure on his foot when they had a press conference following the Sean McDermott firing.
Reports prior to January 21 didn’t hint at this or provide much context as to what was going on with his foot. With the benefit of hindsight, we can look back at the clues throughout the last six weeks and see how this injury unfolded.
The Original Injury
Looking back at this injury, he originally hurt it against the Cleveland Browns in Week 16 trying to evade DE Myles Garrett. He falls over his right foot, gets it looked at and x-rayed in the locker room during halftime and comes back out, limited in his rushing abilities as the Bills win the game.
He was able to play in the following game against the Philadelphia Eagles and tweaked the ankle again midway through the third quarter as seen below.
Then, we got a report from Ian Rapoport further describing Allen’s foot injury. The report clarified that his injury was on the outside portion of the foot, that it was from an old bone injury, and that it was irritated. Rapoport also went on to say it was a pain tolerance issue.
Knowing what we knew about how he injured the foot, the additional details from Rapoport, and the fact he may need a procedure narrowed some things down for us.
Finally, during Mitch Morse’s podcast on January 21, Dawson Knox mentioned that Josh Allen broke his foot, though he did say break and Morse cut in, preventing Knox from saying the full issue. Knowing what we know about the location of the injury, this fits what was mentioned above.
To listen to the clip, please click below.
https://youtube.com/clip/UgkxpIuuV_eGJiLthO81itwpGshqVIe3cfel?si=SaZ9q6FYWXJcKLH9
Old Bone Injury
Looking back, Allen had never been on the injury report for a right foot injury. He did have a left foot injury in 2021. He had been on for a right ankle injury in Week 12 of the 2020 season and Week 5 of the 2024 season.
The 2020 injury was when he was taken down awkwardly by then Chargers DE Joey Bosa, appearing to suffer an MCL sprain and high-ankle sprain. I don’t think this was the cause of the old bone injury.
As for his 2024 injury, he rolled his ankle and confirmed it against the Houston Texans as seen below. They did have him on the injury report for an ankle at the time but likely affected his foot as well. This injury at the time could have caused an avulsion fracture at the fifth metatarsal. Why this was an ankle and not foot comes down to how they categorize things on the injury report. Another example where we don’t always get the full truth. He only spent one week on the report with a right ankle designation.
He also appeared to have a similar mechanism of injury against the Eagles, rolling his ankle then as well as mentioned above.
Foot Fractures
After hearing the news he could require a procedure, I initially had thought that Allen could have suffered an avulsion fracture of the fifth metatarsal, Jones fracture or Dancer’s fracture in his foot. A Jones fracture is a fracture at the base of the fifth metatarsal and can fracture in several different zones including an avulsion fracture. A Dancer’s fracture is in the same location, but more in the shaft of the bone.
Both have a similar mechanism of injury with rolling the foot inward with the Dancer’s fracture having the weight over the balls of the feet and plantarflexed. Jones fracture is more when the ankle is rolled inward with the foot plantarflexed while the heel is inverted inward.
Depending on where a fracture would be and how significant it is can dictate treatment.
We now know that this was an avulsion fracture which means this was in the Zone 1 area at the end of the metatarsal, these can heal well without surgery due to the good blood supply. This is the result of a part of bone pulling off with the tendon, also known as a pseudo-Jones fracture.
This is technically not a true Jones fracture, but in the same area. Considering this was an old injury that was causing issues after aggravating it led to the surgery. Surgery is typically indicated for displacement greater than 2 millimeters or if the area was comminuted or otherwise fragments. My guess is that it was greater than 2 millimeters displaced.
Reports were that he had the surgery in Birmingham, Alabama. The Andrews Sports Medicine center is based in Birmingham and according to their website, there are two foot/ankle specialists listed, Charles Pitts, MD and Norman Waldrop, III, MD. My bet is that he had Waldrop perform his surgery on Monday and then came up to Buffalo shortly after. This was the same surgeon that fixed Denver Broncos QB Bo Nix’s ankle after he suffered the fracture against the Bills in the divisional round.
Had this been in Zone 2, there is a chance for non-union healing which would require surgery. If this is in Zone 3, this could be a stress fracture and if it does not heal, then surgery would be recommended. Had Allen suffered a fracture in either of these areas, surgery would be indicated, the orthopedic surgeon would place an IM screw in the bone in order to allow the bone to fully heal together.
Timeline to Return
Ian Rapoport noted that this would be a 8-10 week recovery. Looking at the research, the type of fracture Allen had makes up 90 percent of the fifth metatarsal fractures as a result of inversion injuries, secondary to the pull of the lateral band of plantar fascia and peroneus brevis tendon.
Considering there wasn’t really anything to truly repair, the concerns to re-injure are almost non-existent from my perspective. I don’t see anything in the literature for risks to re-injure when looking at an avulsion fracture specifically. He could hypothetically suffer the same injury again if he were to roll his ankle, but his previous injury wouldn’t put him at any increased risk.
Had Allen needed a true Jones fracture repair, the literature recommended waiting at least 10 weeks before returning to play significant cuts down on re-injury, fitting in line with what was mentioned earlier. Considering it’s the offseason, there should be absolutely no rush to get back onto the field.
Final Thoughts
Josh Allen is one tough dude. He even said that he would have played had there been another game. The training staff likely padded the shoe and numbed up the area to allow him to gut through on top of all the adrenaline flowing through him.
This is also the first publicly known surgery that Allen had undergone since suffering a right collarbone fracture in college back in 2015.
I’m glad this injury was not worse, but this also shows why the Bills were comfortable to allow him to play despite the injury. Yes, by definition, this was a fracture, but this was relatively minor which allowed him to be there for his team. I would like to wish Josh Allen the best of luck in his recovery as he prepares for 2026.
Top Photo Credit: Jeffery Barnes/AP
Discover more from Banged Up Bills
Subscribe to get the latest posts sent to your email.
