Penn State standout Abdul Carter recently made headlines — not just for his on-field dominance but for a stress reaction in his right foot that’s raising questions about his 2025 NFL Draft future.

Dr. Edward Hur, a foot and ankle orthopedic surgeon at Midwest Orthopaedics at Rush, unpacks this injury for an expert overview of stress reactions, their causes, and what they mean for athletes like Carter.

Here’s everything you need to know:

What is a stress reaction?

Stress injuries to the foot in athletes are commonly caused by overuse.  The repetitive activity does not allow the bone to heal and recover from the overload of activity.  Stress injuries include a wide spectrum of disease.  Mild stress injuries can cause inflammation in the bone and if severe, it can result in a break in the bone commonly called a stress fracture.  A stress reaction is an injury where there is not a true break in the bone, but if not treated, can worsen and cause a stress fracture 

How is a stress reaction diagnosed?

Some severe stress injuries can be seen on X-ray.  However, most of the time, X-rays are normal and stress injuries typically require an MRI for diagnosis.  An MRI can show inflammation in the bone and even reveal a hairline break in the bone that cannot be seen on X-ray.  

What is the treatment of stress reactions?

Treatment varies based on the severity and type of injury.  If mild, treatment typically includes protecting the bone by modifying activity and limiting weight on the foot, and may include immobilization in a boot or cast.  Once pain is improved, athletes can gradually return to activity. If it does not heal or if the injury is severe, surgery can be considered to stabilize the bone with metal plates and/or screws.  This can help reinforce and protect the bone from further injury and allow it to heal.  Some other treatments can be considered, including vitamin D and calcium to help improve bone health and even the use of a device called a bone stimulator that can help the healing process.

What type of stress reaction does Abdul Carter have?

It is not clear what type of stress reaction Abdul Carter has. Any bone in the foot can sustain a stress reaction. However, common stress injuries in the foot include the heel bone, navicular, sesamoid, and metatarsal bones.  Some stress injuries are at a high risk of poor healing and often require early surgery including the navicular bone and fifth metatarsal.  Early reports state that he is not expected to undergo surgery at this time, so it is likely he has a less severe injury to a low-risk bone. 

Will he be able to return from this injury, and when will he return?

Again, the type of stress reaction or location of his injury will dictate his return to play. Mild injuries can heal within 4-6 weeks, while more severe injuries can last longer than 8 weeks. Some injuries do not respond to nonsurgical treatment, and if he continues to have pain, he may need surgery. However, the prognosis is good as most athletes are able to fully recover and return to the same level of performance once healed.