Abreu to DL/Eaton Reinstated

[Balta1701]

See my post in the Abreu thread, you have to believe in a pretty awesome acting job and conspiracy by everyone involved to believe that. Jose was seen my multiple media members visibly distraught post game. That doesn't sound like a guy that was told he'd be going on the DL far in advance.

 

People need to put down the Schneider cool aid, it's affecting common sense badly.

I think Rock is probably right that they suspected he'd need some time off to deal with this.

 

I also think that, if they knew that, then putting him back out there every day and watching him get worse and struggle more was lunacy.

[chitownsportsfan]

I think Rock is probably right that they suspected he'd need some time off to deal with this.

 

I also think that, if they knew that, then putting him back out there every day and watching him get worse and struggle more was lunacy.

 

Here is the inescapable conclusion from those assumptions, and it leads to only one thing -- someone getting fired.

 

1) They knew he'd need a DL trip

2) They knew he has an injury that only gets better with rest

 

If those two things are both true, and they continued to play him, then guess what -- someone should get fired.

 

I choose to believe the much simpler explanation that doesn't involve smoke and mirrors, just good old regular incompetence -- Jose talked his way into the lineup -- something that should never happen.

[Balta1701]

Here is the inescapable conclusion from those assumptions, and it leads to only one thing -- someone getting fired.

 

1) They knew he'd need a DL trip

2) They knew he has an injury that only gets better with rest

 

If those two things are both true, and they continued to play him, then guess what -- someone should get fired.

 

I choose to believe the much simpler explanation that doesn't involve smoke and mirrors, just good old regular incompetence -- Jose talked his way into the lineup -- something that should never happen.

That was what I meant. It was a terrible decision.

[Jake]

If you thought the worst case was 15-day DL but there was some chance it could get better without 15-day DL, the only insane thing to do would have been to send him straight to DL

[caulfield12]

 

Let's just hope that the DL stint clears things up.

 

Along with Sale TJ surgery, this doesn't look like the greatest injury in the world for someone of Jose's size to be dealing with from a medical perspective.

 

 

Surgical Treatment

Surgery should only be done if the pain does not get better after 6 months of appropriate treatment. The type of surgery depends on where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. The following is a list of the more commonly used operations. Additional procedures may also be required.

 

Gastrocnemius Recession or Lengthening of the Achilles Tendon

This is a surgical lengthening of the calf muscles. It is useful in patients who have limited ability to move the ankle up. This surgery can help prevent flatfoot from returning, but does create some weakness with pushing off and climbing stairs. Complication rates are low but can include nerve damage and weakness. This surgery is typically performed together with other techniques for treating flatfoot.

 

Tenosynovectomy (Cleaning the Tendon)

This surgery is used when there is very mild disease, the shape of the foot has not changed, and there is pain and swelling over the tendon. The surgeon will clean away and remove the inflamed tissue (synovium) surrounding the tendon. This can be performed alone or in addition to other procedures. The main risk of this surgery is that the tendon may continue to degenerate and the pain may return.

 

Tendon Transfer

Tendon transfer can be done in flexible flatfoot to recreate the function of the damaged posterior tibial tendon. In this procedure, the diseased posterior tibial tendon is removed and replaced with another tendon from the foot, or, if the disease is not too significant in the posterior tibial tendon, the transferred tendon is attached to the preserved (not removed) posterior tibial tendon.

 

One of two possible tendons are commonly used to replace the posterior tibial tendon. One tendon helps the big toe point down and the other one helps the little toes move down. After the transfer, the toes will still be able to move and most patients will not notice a change in how they walk.

 

Although the transferred tendon can substitute for the posterior tibial tendon, the foot still is not normal. Some people may not be able to run or return to competitive sports after surgery. Patients who need tendon transfer surgery are typically not able to participate in many sports activities before surgery because of pain and tendon disease.

 

Osteotomy (Cutting and Shifting Bones)

An osteotomy can change the shape of a flexible flatfoot to recreate a more "normal" arch shape. One or two bone cuts may be required, typically of the heel bone (calcaneus).

 

If flatfoot is severe, a bone graft may be needed. The bone graft will lengthen the outside of the foot. Other bones in the middle of the foot also may be involved. They may be cut or fused to help support the arch and prevent the flatfoot from returning. Screws or plates hold the bones in places while they heal.

 

X-ray of a foot as viewed from the side in a patient with a more severe deformity. This patient required fusion of the middle of the foot in addition to a tendon transfer and cut in the heel bone.

 

Fusion

Sometimes flatfoot is stiff or there is also arthritis in the back of the foot. In these cases, the foot will not be flexible enough to be treated successfully with bone cuts and tendon transfers. Fusion (arthrodesis) of a joint or joints in the back of the foot is used to realign the foot and make it more "normal" shaped and remove any arthritis. Fusion involves removing any remaining cartilage in the joint. Over time, this lets the body "glue" the joints together so that they become one large bone without a joint, which eliminates joint pain. Screws or plates hold the bones in places while they heal.

 

 

This x-ray shows a very stiff flatfoot deformity. A fusion of the three joints in the back of the foot is required and can successfully recreate the arch and allow restoration of function.

 

Side-to-side motion is lost after this operation. Patients who typically need this surgery do not have a lot of motion and will see an improvement in the way they walk. The pain they may experience on the outside of the ankle joint will be gone due to permanent realignment of the foot. The up and down motion of the ankle is not greatly affected. With any fusion, the body may fail to "glue" the bones together. This may require another operation.

 

Complications

The most common complication is that pain is not completely relieved. Nonunion (failure of the body to "glue" the bones together) can be a complication with both osteotomies and fusions. Wound infection is a possible complication, as well.

 

Surgical Outcome

Most patients have good results from surgery. The main factors that determine surgical outcome are the amount of motion possible before surgery and the severity of the flatfoot. The more severe the problem, the longer the recovery time and the less likely a patient will be able to return to sports. In many patients, it may be 12 months before there is any great improvement in pain.

 

Top of page

Last reviewed: December 2011

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.

http://orthoinfo.aaos.org/topic.cfm?topic=a00166

 

 

 

[jamesdiego]

Way to early to even think of surgery. That should be a last resort. They were stupid to try and play him and rehab at the same time. He would probably be pain free shortly with the proper treatment and rest. Strengthening and stretching program afterwards I imagine. And hope he doesn't re-injure it again

[oldsox]

The SI cover jinx is still alive.

[Soxfest]

The SI cover jinx is still alive.

Yes it is dammit.

[ptatc]

The ptatc bat signal has been turned on

Surgery is rare for this problem. It is commonly treated with rest and othotics. It is a very tricky problem with a man his size. The posterior tib is connected to the navicular bone. This bone is important because it is the keystone bone for the medial arch. The poterior tib helps to hold upthe arch. Sowhen he puts his foot down and the arch lowers the tendonopathy will hurt. So eachtime he steps the tendon will hurt. For treatment it is rest to decrease the inflammation then orthtics to support the arch to decreasethestresson thetendon. The only surgery they could do is a tarsal tunnel release. Just like carpal tunnel in the wrist tendons around the ankle can swell and cause compression. So they cut through the retinaculum on the inside of theankle to relieve this pressure. I've seen it in runners but it's fairly rare.

[Quin]

Surgery is rare for this problem. It is commonly treated with rest and othotics. It is a very tricky problem with a man his size. The posterior tib is connected to the navicular bone. This bone is important because it is the keystone bone for the medial arch. The poterior tib helps to hold upthe arch. Sowhen he puts his foot down and the arch lowers the tendonopathy will hurt. So eachtime he steps the tendon will hurt. For treatment it is rest to decrease the inflammation then orthtics to support the arch to decreasethestresson thetendon. The only surgery they could do is a tarsal tunnel release. Just like carpal tunnel in the wrist tendons around the ankle can swell and cause compression. So they cut through the retinaculum on the inside of theankle to relieve this pressure. I've seen it in runners but it's fairly rare.

 

What would you say the "time to jump off the cliff" level is, on a scale of 1-10 so far based off what we know?

[ptatc]

Let's just hope that the DL stint clears things up.

 

Along with Sale TJ surgery, this doesn't look like the greatest injury in the world for someone of Jose's size to be dealing with from a medical perspective.

 

 

Surgical Treatment

Surgery should only be done if the pain does not get better after 6 months of appropriate treatment. The type of surgery depends on where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. The following is a list of the more commonly used operations. Additional procedures may also be required.

 

Gastrocnemius Recession or Lengthening of the Achilles Tendon

This is a surgical lengthening of the calf muscles. It is useful in patients who have limited ability to move the ankle up. This surgery can help prevent flatfoot from returning, but does create some weakness with pushing off and climbing stairs. Complication rates are low but can include nerve damage and weakness. This surgery is typically performed together with other techniques for treating flatfoot.

 

Tenosynovectomy (Cleaning the Tendon)

This surgery is used when there is very mild disease, the shape of the foot has not changed, and there is pain and swelling over the tendon. The surgeon will clean away and remove the inflamed tissue (synovium) surrounding the tendon. This can be performed alone or in addition to other procedures. The main risk of this surgery is that the tendon may continue to degenerate and the pain may return.

 

Tendon Transfer

Tendon transfer can be done in flexible flatfoot to recreate the function of the damaged posterior tibial tendon. In this procedure, the diseased posterior tibial tendon is removed and replaced with another tendon from the foot, or, if the disease is not too significant in the posterior tibial tendon, the transferred tendon is attached to the preserved (not removed) posterior tibial tendon.

 

One of two possible tendons are commonly used to replace the posterior tibial tendon. One tendon helps the big toe point down and the other one helps the little toes move down. After the transfer, the toes will still be able to move and most patients will not notice a change in how they walk.

 

Although the transferred tendon can substitute for the posterior tibial tendon, the foot still is not normal. Some people may not be able to run or return to competitive sports after surgery. Patients who need tendon transfer surgery are typically not able to participate in many sports activities before surgery because of pain and tendon disease.

 

Osteotomy (Cutting and Shifting Bones)

An osteotomy can change the shape of a flexible flatfoot to recreate a more "normal" arch shape. One or two bone cuts may be required, typically of the heel bone (calcaneus).

 

If flatfoot is severe, a bone graft may be needed. The bone graft will lengthen the outside of the foot. Other bones in the middle of the foot also may be involved. They may be cut or fused to help support the arch and prevent the flatfoot from returning. Screws or plates hold the bones in places while they heal.

 

X-ray of a foot as viewed from the side in a patient with a more severe deformity. This patient required fusion of the middle of the foot in addition to a tendon transfer and cut in the heel bone.

 

Fusion

Sometimes flatfoot is stiff or there is also arthritis in the back of the foot. In these cases, the foot will not be flexible enough to be treated successfully with bone cuts and tendon transfers. Fusion (arthrodesis) of a joint or joints in the back of the foot is used to realign the foot and make it more "normal" shaped and remove any arthritis. Fusion involves removing any remaining cartilage in the joint. Over time, this lets the body "glue" the joints together so that they become one large bone without a joint, which eliminates joint pain. Screws or plates hold the bones in places while they heal.

 

 

This x-ray shows a very stiff flatfoot deformity. A fusion of the three joints in the back of the foot is required and can successfully recreate the arch and allow restoration of function.

 

Side-to-side motion is lost after this operation. Patients who typically need this surgery do not have a lot of motion and will see an improvement in the way they walk. The pain they may experience on the outside of the ankle joint will be gone due to permanent realignment of the foot. The up and down motion of the ankle is not greatly affected. With any fusion, the body may fail to "glue" the bones together. This may require another operation.

 

Complications

The most common complication is that pain is not completely relieved. Nonunion (failure of the body to "glue" the bones together) can be a complication with both osteotomies and fusions. Wound infection is a possible complication, as well.

 

Surgical Outcome

Most patients have good results from surgery. The main factors that determine surgical outcome are the amount of motion possible before surgery and the severity of the flatfoot. The more severe the problem, the longer the recovery time and the less likely a patient will be able to return to sports. In many patients, it may be 12 months before there is any great improvement in pain.

 

Top of page

Last reviewed: December 2011

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.

http://orthoinfo.aaos.org/topic.cfm?topic=a00166

These are all very rare and for more serious problems than a tendonopathy. It usually comes from a bony deformity of flat foot not just a tendonopathy

[caulfield12]

These are all very rare and for more serious problems than a tendonopathy. It usually comes from a bony deformity of flat foot not just a tendonopathy

 

 

So likelihood of surgery is probably 5-10% at best?

 

With someone his size, you worry about the wear and tear over time...just like a Frank Thomas or Yao Ming in basketball. That said, rest is the only effective treatment at this point, along with support/orthotics.

 

 

[ptatc]

So likelihood of surgery is probably 5-10% at best?

 

With someone his size, you worry about the wear and tear over time...just like a Frank Thomas or Yao Ming in basketball. That said, rest is the only effective treatment at this point, along with support/orthotics.

Pretty much. Frank Thomas was different as he had a fracture of the navicular that they tried to piecetogether with screws. Tendonopathy was theleast of his worries. This isthetendon that Mitchell tore a couple of years ago.

[ptatc]

What would you say the "time to jump off the cliff" level is, on a scale of 1-10 so far based off what we know?

3 it's not aserious problem for a non speed guy. It will bother him but it can be managed as long as there is nothing structural involved. By the way they were treating it, I doubt there is anything else going on.

[ptatc]

Way to early to even think of surgery. That should be a last resort. They were stupid to try and play him and rehab at the same time. He would probably be pain free shortly with the proper treatment and rest. Strengthening and stretching program afterwards I imagine. And hope he doesn't re-injure it again

This probably something that will bother him all year. That's why they tried it this way. It wouldn't surprise me if he needs the DL again later. The off season is the only thing that wil lreally help.

[Quin]

3 it's not aserious problem for a non speed guy. It will bother him but it can be managed as long as there is nothing structural involved. By the way they were treating it, I doubt there is anything else going on.

 

ptatc to the rescue once again.

[caulfield12]

http://espn.go.com/video/clip?id=10951020

 

Let's see if ptac agrees with ESPN "injury expert" Stephanie Bell whoever that is.

[southsider2k5]

Surgery is rare for this problem. It is commonly treated with rest and othotics. It is a very tricky problem with a man his size. The posterior tib is connected to the navicular bone. This bone is important because it is the keystone bone for the medial arch. The poterior tib helps to hold upthe arch. Sowhen he puts his foot down and the arch lowers the tendonopathy will hurt. So eachtime he steps the tendon will hurt. For treatment it is rest to decrease the inflammation then orthtics to support the arch to decreasethestresson thetendon. The only surgery they could do is a tarsal tunnel release. Just like carpal tunnel in the wrist tendons around the ankle can swell and cause compression. So they cut through the retinaculum on the inside of theankle to relieve this pressure. I've seen it in runners but it's fairly rare.

 

Out of curiosity, how much does losing weight alleviate a problem like this?

[Kyyle23]

Out of curiosity, how much does losing weight alleviate a problem like this?

 

Allen Thomas seems to think it has a lot to do with it, i read an article from last week where they said he is on a weight program to bring him down to a better weight. Down 15 lbs since the start of the season

[southsider2k5]

Allen Thomas seems to think it has a lot to do with it, i read an article from last week where they said he is on a weight program to bring him down to a better weight. Down 15 lbs since the start of the season

 

That is basically why I asked the question. I was trying to put together if the two things were connected.

[ptatc]

http://espn.go.com/video/clip?id=10951020

 

Let's see if ptac agrees with ESPN "injury expert" Stephanie Bell whoever that is.

I would mostly agree. I think that not only running will bother him but also planting the foot when he swings a bat is also an issue. They tried just DH but it still didn't help enough. I also think that the 15 days won't be enough to fully resolve the problem but it will help to manage it.

[ptatc]

Out of curiosity, how much does losing weight alleviate a problem like this?

The weight really won't cause the problem. most of the people I see with this a runners without weight issues. It's just that the bigger you are the more weight there is on the arch and this tendon. Weight loss will not be a treatment for this but getting better support in his shoes will.

[Dick Allen]

Conditioning coach Allen Thomas said Abreu might deal with soreness the rest of his career because his natural gait puts stress on the inner parts of his legs.

 

From the Sun Times. This is what Thomas was talking about. Supposedly Abreu is about 255 pounds now. Was 270 in spring training. He still looks like a little kid next to Dunn.

[fathom]

This probably something that will bother him all year. That's why they tried it this way. It wouldn't surprise me if he needs the DL again later. The off season is the only thing that wil lreally help.

 

Would they be better off shutting him down for the rest of the year instead of risking a possibly more career-impacting injury?

[Kyyle23]

Would they be better off shutting him down for the rest of the year instead of risking a possibly more career-impacting injury?

 

lets go ahead and schedule Sale's pre-emptive TJS while we are at it