Tim Redding Back on the Mound

LAKELAND, Fla. - Tim Redding threw off a mound Saturday for the first time since being shut down with discomfort in the back of his right shoulder. The right-hander reported no difficulty and said he remained on track to pitch in his first spring game a week from Sunday.

 Redding, who is expected to claim a job as either a long reliever or the No.5 starter, believes the shoulder issue arose because he tried to ramp up activity too quickly upon arriving in camp. He was idle for much of the winter because of Nov.28 surgery to repair a stress fracture in his left, landing foot.

 DR’S RESPONSE:  A stress fracture is essentially a very small incomplete fracture.  It typically is created by repetitive micro trauma.  In this athlete’s case, it is most likely due to the constant barrage created by the planting of the left foot on the turf as the ball is released from his right hand.  By repeatedly stamping down his left foot, he has created an environment where the bone has been injured. 

 Another consideration is which particular bone is injured.  Although the article doesn’t specify the bone, it is important to understand that different parts of the foot heal differently.  This is most often due to the differences in blood flow to different parts of the foot.  For example, the outside of your foot receives less blood flow than the heel.  A fracture on the outside of the foot would normally take longer to heal than a fracture in your heel. 

 Stress fractures are treated in a variety of ways.  The most common method of treatment involves rest and immobilization.  The thought is that removal of the offending repetitive injury will allow the bone in question a good chance to heal.  By maintaining a non weight bearing foot, the body’s ability to heal is accelerated significantly because the bone surfaces are not being constantly disrupted, as they would be in normal walking. 

 Another treatment option is the use of a bone stimulator.  This fancy contraption sends micro amounts of voltage several times a day to the bone fracture site.  The proven theory behind this is that electricity stimulates the cells in the area of the fracture to respond with more potential. Small amounts of electricity “excite” these cells and spur them into action.  By increasing the productivity of these cells, the length of time for a fracture to heal is reduced. 

 Another treatment option is surgery.  Although this is rare, there are a few indications where a surgical approach would be most appropriate.  An athlete who has a limited time schedule due seasonal commitments would be a prime example.  Other reasons to consider surgery include worsening of the fracture or gaping at the fracture site and lack of improvement secondary to previous treatment methods.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

Durant will miss up to two weeks with a Grade II ankle sprain

Thunder forward Kevin Durant will miss up to two weeks with a Grade II ankle sprain, according to a team source.

 Oklahoma City Thunder guard Kevin Durant (35) holds his leg after injuring himself against the Dallas Mavericks during an NBA basketball game in Dallas, Friday, Feb. 27, 2009. Durant left the game. (AP Photo/LM Otero)

 Durant is expected to miss seven to 14 days after rolling his right ankle in Friday’s game atDallas when he stepped on the foot of Mavs forward Josh Howard while driving to the basket with 7:13 left in the first quarter. He remained in the game for about three minutes before walking off the court with a limp.

 Team officials said X-rays taken on Durant’s foot were negative, but Durant wore a protective boot on his right foot and walked with the aid of crutches following the Thunder’s 110-108 overtime loss.

 Grade II sprains can include damage or tearing of ligaments or a joint capsule and are characterized by swelling, extensive bruising, pain and difficulty bearing weight.

 Durant is the NBA’s fourth leading scorer at 26.0 points per game and is averaging 30.6 points in February. Durant had missed only one game this season, a Nov. 12 home game againstOrlando because of a sprained left ankle.

 DR’S RESPONSE:  Ankle sprains can conceivably ruin your day.  Because these are so common and are seen on a daily basis, podiatric physicians have become masters at treating this condition.  Let me give a brief overview of this condition.

 There are two main kinds of ankle sprains.  We can roughly separate them into those on the inside of the ankle and those on the outside of the ankle.  The most common type is those that affect the outside of the ankle.  This is due to a variety of reasons, the most significant of which is related to the biomechanics of your foot type.  Specific types of feet, like high arches, tend to have more of these types of injuries.  A sprain that stretches the soft tissues on the outside of your foot is referred to as an inversion type of injury.  A sprain which affects the inside of your ankle is far less common and this type of injury is called an eversion sprain.  Again, biomechanics has some input regarding this type of injury, but also the fact that these particular soft tissues are stronger and more strategically placed also has a lot to do with making these type of injuries less common.

 Let’s discuss the more common type of ankle sprain, the inversion injury.  There are three main ligaments on the outside of your ankle.  A ligament is a band of soft tissue which connects one bone to another bone.  Ligaments are typically placed at certain locations to limit or diminish movement of the local bones.  A wider or stronger ligament will resist these forces much better than a smaller or poorly placed ligament. 

 Looking at the anatomy of an ankle, the three ligaments are pretty much equally spaced around the outside of the ankle.  There is one at the front outside, and the middle outside, and one at the back outside of the ankle joint.  Let’s call those ligaments 1, 2, and 3 respectively.  Conveniently, the order of tearing or rupture of those ligaments is exactly the same as their number.  For instance, a grade I sprain indicates that the ligament at the front outside of the ankle joint has been injured.  This ligament is the most common one to be injured because when a ankle rolls, there is significant stress applied to this ligament first. 

 A grade II injury, as in this athlete’s case, refers to an injury that has affected the first AND second ligaments that we previously mentioned.  In other words, this athlete has sprained the front and middle outside ligaments but has not affected the back outside one.  Finally, a grade III injury is quite rare.  This is because the back outside ligament is not only the strongest ligament on the outside of the ankle but also the most strategically placed ligament.  It is virtually impossible to rupture without a significant force being applied to it.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com