Billups Out for Season with Achilles Tear

Chauncey Billups will be forced to sit out the rest of the NBA season with a torn Achilles tendon.  The injury came in Monday night’s game against the Orlando Magic, as Billups’ Clippers went on to beat the Magic 107-102 in overtime.  Billups, who is 35 years old, reports that he had not previously had any pain in his Achilles tendon.  The tear, however, was confirmed with MRI on Tuesday.  Billups will undergo surgery to repair to torn tendon, and promises to return to the league.

Achillles tendon tears can often occur just like they have to Chauncey Billups, with no real history of pain in the area.  However, what is common in Achilles tendon tears is that there is degenerative disease in the tendon that precedes the tear.  This degenerative disease is usually appreciated in the operating room under direct visualization when the tendon is repaired, even when the MRI reads the tendon as normal.  This is because the changes can often be too subtle to pick up MRI.  The degenerative condition is referred to as tendinosis of the Achilles tendon, and when there is an acute incident of pain without a rupture, it is called tendinitis.

Surgical repair of Achilles tendon tears and ruptures involves cleaning up the ends of the tendon and removing any scar tissue that may be present in the tendon.  A more normal shape and appearance of the tendon is achieved using strong sutures to and strength to the tendon as it heals.  Post-operatively, the patient is placed in a cast and remains non-weight bearing for several weeks.  Following removal of the cast, aggressive physical therapy is initiated for rehabilitation.  The timeline for complete healing of the surgical site is usually between three and six months, and a return to full strength may come after complete healing has occurred.  In a professional athlete such as Chauncey Billups’ case, this usually means the season ends early. 

Billups, a five-time NBA All-Star, will certainly be missed on the court.  He is considered one of the strongest leaders in the league, and has a way of boosting team morale both on and off the court.  He was picked up by the Los Angeles Clippers from the New York Knicks, and has become a key role in the team’s ascent to the top of the Western Conference.  They are in serious contention for the championship this year, in part due to Chauncey Billups.  Hopefully he will be back on the sidelines soon, his presence giving the Clippers motivation to win. 

  

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. 
Winter Haven, Fl. 33881 
863-299-4551 
www.FLFootandAnkle.com

Gronkowski Expected to Play in Super Bowl

The New England Patriots’ victory on Sunday over the Baltimore Ravens sends the Pats to the Super Bowl, but a scary moment came in the third quarter when tight end Rob Gronkowski went down with what looked like a serious injury.  After catching a short pass, Gronkowski was tackled and had his left ankle trampled in the process.  The injury looked bad at first, and Gronkowski was helped off the field.  He later returned to the game in the fourth quarter, but was seen wearing a boot after the game.

The Boston Herald is reporting that Gronkowski’s ankle is “fine”, and that he’ll be ready to play in two weeks when the Patriots take on the New York Giants in the Super Bowl.  This news comes as a relief to Patriots fans everywhere.

Ankle injuries in football and other sports are a common occurrence.  The anatomy of the ankle is such that a number of different structures may be injured following trauma to the ankle.  The most common types of injuries are sprains of the lateral ankle ligaments.  These include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL).  The medial ankle ligaments include the superficial and deep deltoid ligaments, which are less commonly affected by rotational ankle injuries. 

Fractures of the ankle can also occur, including fractures of the lateral malleolus (outside ankle bone), and the medial malleolus (inside ankle bone).  The talus, which sits between these two structures in the ankle joint, can also be affected.  Most commonly, the talus may have an osteochondral lesion, which is a chip in the joint surface. 

High ankle sprains are injuries to the syndesmosis of the ankle, and can be very slow healing injuries that are prone to complications.  These can be quite severe injuries, and may be associated with the development of long-term instability of the ankle.

A number of tendons cross the ankle joint, and can also become damaged in an injury.  Most notably, the peroneal tendons, which run along the outside of the ankle, may become strained or even dislocated in a rotational-type of injury. 

Fractures of some of the bones of the foot may also be seen in rotational-type ankle injuries, including the fifth metatarsal, the cuboid, the navicular, and the anterior process of the calcaneus.  A thorough work-up with x-rays is almost always warranted. 

While it is not clear what anatomic structures Rob Gronkowski’s injury involves, it is good news that the medical staff is anticipating his return for the Super Bowl.  He is certainly a major asset to the Patriots, and plays a vital role in their offense.  

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. Winter Haven, Fl. 33881 
863-299-4551 
www.FLFootandAnkle.com

DeMarco Murray out for Season with Broken Ankle

DeMarco Murray, running back for the Dallas Cowboys, will be out for the rest of the season with a broken ankle.  The injury came this Sunday night in the first quarter of the game against the New York Giants, as Murray was pulled down at the end of an eight-yard gain.  His ankle was pinned against the turf, and the injury is being reported as an ankle fracture and a high ankle sprain.

The rookie was a key asset to the Cowboys’ offense this season in their search for a playoff spot, but will sit the rest of the season as the injury heals.  He had run for 25 yards already in the game, giving him 899 for the season.  The combination of ankle fracture and high ankle sprain will certainly require some attention from the Dallas medical staff and trainers. 

Ankle fractures are a common pathology during sports, and can occur from either direct or indirect mechanisms.  Indirect mechanisms imply a twisting force placed across the ankle when the foot is held in place.  This is particularly common in football, as is the diagnosis of a high ankle sprain. 

A high ankle sprain refers to damage to the ankle syndesmosis, which is a structure that keeps the tibia and fibula in close contact, helping to create and stabilize the ankle joint.  An injury to the syndesmosis can often lead to long-term damage and instability in the joint.  These sprains are often treated with surgery, where a screw is placed across the syndesmosis to prevent it from moving while the tissues are allowed time to heal.  In the case of DeMarco Murray, it is uncertain whether surgery will be necessary. 

 Ankle fractures can be treated conservatively, often immobilizing the ankle and leg in a short leg cast or a removable boot and keeping weight off of the leg while it heals.  For ankle fractures that have become displaced, meaning that the ends of the broken bone do not line up with each other, surgery may become necessary to achieve a favorable outcome. Surgery for ankle fractures involves the use of screws and plates, which may be necessary to use on both sides of the ankle.  In the case of ankle fracture combined with high ankle sprain, it becomes very important to stabilize the ankle sprain with a screw across the tibia and fibula, the leg bones that create the ankle joint.  Without this stabilization, motion across the screw will cause the screw to fail, and the fracture fragments will be allowed to move apart.

As for DeMarco Murray, he will hopefully be able to heal his injury rapidly, and return to a productive career.  The rookie running back was having a great season before the injury, rushing for 293 yards in October, the seventh-most in the history of the NFL.

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. 
Winter Haven, Fl. 33881 
863-299-4551
www.FLFootandAnkle.com

Despite Sprained Foot, Roethlisberger Gets It Done

Earlier in the week, it looked like Steeler’s quarterback Ben Roethlisberger may have broken his foot.  He hobbled all week in practice, and was nowhere near full speed.  While the team never released details of exactly what the injury was, it looked like a sprain in his foot. 

That sprain didn’t slow him down one bit on Sunday, as he and the Steelers roled over the Tennessee Titans, with a final score of 38-17.  Roethlisberger threw for 228 yards and five touchdowns.

While there was no diagnosis released to the press, the pain was reported as being across the forefoot, and Big Ben hobbled noticeably at times during the game.  With the pain being localized around the metatarsophalangeal joints, the possibility of a plantar plate injury, tendinitis, irritation of the capsular ligaments of the MTP joints, and many other conditions become possibilities. 

Of his foot, Roethlisberger told the press “I told ya, I was just faking it, I’m a wimp.”

Over the next week, fans will have to keep an eye on Roethlisberger during practice to determine the fate of his left foot. 

Most likely, it seems as though Roethlisberger may have sprained one of the capsular ligaments of one of the lesser metatarsophalangeal joints.  These injuries are typically minor, and will resolve with rest, ice, and compression.  If that is the case, he should be fine for next week, when the Steelers face the Arizona Cardinals. 

Sprains of the foot are treated conservatively.  This involves PRICE therapy, with protection, rest, ice, compression, and elevation.  Depending on what joint is affected, various types of braces may be used.  Sprains of the rearfoot and ankle can be particularly worrisome, and will usually require various splinting and bracing techniques. 

A sprain happens when a ligament of a joint is extended past its normal range of motion.  Extra stress is placed on the ligament as it is brought through an abnormal range of motion, and this creates a painful situation that is quickly followed by inflammation around the joint.  This inflammation adds to the pain, and is the reason that a sprain can last several weeks and is slow to get over.  In order to fight the inflammation, non-steroidal anti-inflammatories are often added to the treatment protocol, as well as compression and elevation. 

Roethlisberger performed strongly on Sunday, but may not be out of the woods yet.  He is a player that performs strongly when he’s hurt, but he’ll have to practice smart over the next week.

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. 
Winter Haven, Fl. 33881 
863-299-4551 
www.FLFootandAnkle.com

Kevin Williams will play despite plantar fasciitis

Kevin Williams, the All-Pro defensive tackle of the Minnesota Vikings, said that he will play through his plantar fasciitis in the opening day matchup against San Diego.  “It’s a situation where I feel it’s not going to go away until maybe the offseason,” Williams said to the press.  “We’re just going to deal with it and try to grin and bear it”.  It sounds as though Williams knows that his left foot won’t be feeling much better any time soon, but he’s willing to shake it off and continue on with practice and with the beginning of the season. 

Amongst athletes both professional and amateur, this reaction to plantar fasciitis is quite common.  Many people will chose to perform through the pain, and eventually it may even stop. 

The plantar fascia is a strong piece of fibrous tissue, organized into an aponeurosis, that runs along the bottom of the foot.  It attaches the heel bone (calcaneus) to the digits.  An increase in pressure and force along the plantar fascia can often create a painful sensation, most commonly in the bottom of the heel.  The pain is especially strong with the first few steps out of bed in the morning, or after a long period of sitting. 

Plantar fasciitis is extremely common, and accounts for approximately 15% of all podiatry visits.  It is the most common cause of heel pain in adults, and accounts for roughly 9% of all running injuries.  Between 1995-2000, there were over 1 million patient visits to U.S. hospitals and hospital-based outpatient centers that were diagnosed with plantar fasciitis.  It is easy to see that professional football players and other athletes are not the only ones affected by plantar fasciitis.  It is also commonly associated with obesity, flat feet, poorly fitting shoes, and excessive periods of walking, standing, or running. 

The vast majority of plantar fasciitis cases are treated conservatively.  This will generally includes such things as rest, ice, various taping methods, orthotics, steroid injections, and night splints, as well as a change in shoegear.  Rarely do these cases go on to surgical intervention. 

As for Mr. Williams, it may be quite accurate that his heel pain does not totally resolve until the season is over.  Will it hinder his ability on the field?  That is something for Vikings fans to wait and see.  However, it is quite possible that with aggressive conservative therapy, which he is likely already receiving, he will be just fine to continue with the season. 

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. 
Winter Haven, Fl. 33881 
863-299-4551 
www.FLFootandAnkle.com

Titus Brown out with High Ankle Sprain

Cleveland Browns’ linebacker Titus Brown will be sidelined with a high ankle sprain. The Browns have been pummeled with injuries this preseason. Titus Brown will join teammates Eric Steinbach (tackle) and Brandon Jackson (running back) and Jordan Norwood (wide receiver) on the injured list. With a season opener on September 11 against the Cincinnati Bengals, things are not looking good for Cleveland.

A high ankle sprain is an injury to the syndesmosis between the tibia and fibula. The ligaments that attach the tibia to the fibula aid in stabilizing the ankle joint. These ligaments can become sprained or even torn when the leg is forced to rotate outwards with a planted foot. This is a common injury in contact sports, football in particular.

The syndesmosis is composed of the anterior and posterior inferior tibiofibular ligaments. In a sprain, usually only one of these ligaments is injured. The syndesmosis can also be injured in ankle fractures, where the fibula is destabilized and allowed to rotate.

The diagnosis is usually suspected through history and physical examination, and may be confirmed with x-rays and an MRI. MRI may not be necessary for everyone, but can help differentiate between a sprain and a tear of the ligaments. For high-level athletes, MRIs are typically ordered swiftly.

Once the diagnosis is confirmed, high ankle sprains are treated with a period of immobilization in a cast for about 6 weeks. Anti-inflammatory medications and pain relievers may also be used in conjunction with immobilization to relieve the symptoms. Following immobilization, a period of rehabilitation will begin. This generally involves aggressive stretching and strengthening exercises, with a slow return to full weight bearing and activity.

For cases requiring surgery, a screw may be placed across the syndesmosis from the fibula to the tibia. This screw helps immobilize the joint while the ligaments heal, and is left in place for about three months. Patients are instructed not to walk on the leg while the screw is in place, as it could break with motion. The screw is taken out once the ligaments have healed, and an aggressive physical therapy rehabilitation program begins.

As for Brown, no surgery has been scheduled, and he’s been placed in a cast. For Cleveland Browns fans, this is good news, as the linebacker will likely return later in the season. While he won’t be ready for the regular season opener, he may be ready to return to play mid-season.

Central Florida Foot and Ankle Center, LLC.101 6TH St. NW. Winter Haven, Fl. 33881 863-299-4551http://www.FLFootandAnkle.com

Lions’ Leshoure Out with Achilles Rupture

Detroit Lions rookie running back Mikel Leshoure will be out for the season following an Achilles tendon rupture sustained during practice on Monday. The Lions drafted Leshoure in the second round from the University of Illinois, and were hoping to have him take turns carrying the ball with Jahvid Best. Of Leshoure, Coach Jim Schwartz said "He’ll have surgery very soon, probably tomorrow, and he’ll be back. He won’t be back this year, but he’ll be back. And he was doing very well."

Achilles tendon injuries can be a career-ending injury, which certainly takes some air out of the tires of the Detroit Lions, who sports pundits are predicting to have a turn-around year. In a systematic review of statistics from the NFL, Parekh et al showed that 36% of skill-players (running backs, wide recievers, defensive backs, cornerbacks, and linebackers) never returned to play professionally.

The study analyzed the power ratings of the players who did return to play professionally. Power ratings are statistics used to measure a player's level of play, such as rushing and passing yards. Of the 64% who returned to play (21 players total), all showed a significant decline in their power ratings as well as the number of games played. This 64% is slightly lower than the previously reported 71% of patients returning to full activity following surgical repair of Achilles tendon ruptures. This difference may be attributed to size, weight, strength, and overall physical demand of professional football players when compared to the average young athlete.

The study by Parekh et al looked at the three seasons before injury and the three seasons following injury, and averaged statistics for the players over those three years. It was found that the power ratings fell by average of almost 50%, and that the amount of games played fell from 11.67 to 6.17. This suggests that even if a player is able to recover from the injury and return to their previous level of play, they may never regain their original quality of play.

Current treatment regimens hinge on surgical repair of the ruptured tendon. While studies have shown promising reults with conservative non-surgical treatment combined with aggressive rehabilitation protocols, the incidence of re-rupture is lower in surgically repaired Achilles tendons, and the time to full recovery is also faster. Surgeons are trending towards earlier, aggressive physical therapy regimens following surgery instead of the six to eight weeks of immobilization previously set as the standard of care.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com