The Ankle Bone is Connected to the…

TCR is happy to announce the addition of Joseph Hecht, M.D. as a guest contributor to the site. You may recall his detailed insights in the comments as "Cubster" on the various medical woes that our team has suffered throughout the years. He's a board certified orthopedic surgeon with over 20 years of experience, currently running a private practice just outside of Chicago, in Munster, Indiana. He'll be providing us with insight on the various ailments that will undoubtedly befall the boys in blue as the season progresses. --- Cliff Floyd, the most recent Cub addition will immediately fit in with the Cub tradition as he’s been a walking wounded athlete much of his career. His current malady for which he had surgery last October is Achilles Tendonitis. Recent Cubs surviving this Epic Malady include the “Marks” Grudzielanek and Prior, although neither of those athletes needed surgery for the condition. From Greek Mythology and Homer’s Iliad come the origin of the concept that the Achilles tendon is the weak spot of many a legendary hero. Thetis (Achilles Mother) held the young Achilles by the heel and dipped him in the river Styx; everything the sacred waters touched became invulnerable, but the heel remained dry and therefore vulnerable. I don’t believe Cliff Floyd’s mom’s first name is Thetis although she might have listened to a song or two from the band Styx. But seriously folks, this stuff hurts… Achilles Tendonitis is an overuse syndrome. During running the tendon can transmit up to ten times the body weight. So doing the math: Cliff Floyd at 6 foot 4 inches and 230 lbs.; 10 x 230 = 2300 lbs Makes me want to slowly stretch my ankles… Consequently, the Achilles tendon is subject to inflammation, degeneration and even ruptures. Achilles tendonitis simply put is inflammation and degeneration. More specifically it is categorized by the specific location where the inflammation occurs, either in the tendon itself or at the location where the tendon inserts into the heel bone (aka calcaneus). Basic initial treatment is rest, anti-inflammatory medications, shoe modifications including arch supports or heel lifts and stretching exercises followed by modifications in the ballplayers training program. In a pitcher, we all know that much of their velocity comes from the legs and the Achilles transmits the added leverage that the mound gives to that push off. Longer legs and bigger calf muscles mean more force being transmitted across the tendon. No wonder our prodigy pitcher with this problem has the nickname “calf-zilla”. The tendon itself has a limited amount of blood supply and there is an area about 1-2 inches above where it inserts into bone that has even less vascularity, making that area susceptible to microscopic tearing of the collagen or fibrous tissue that makes up the tendon. When the condition becomes chronic, usually not responding to treatment for over 6 months, surgical treatment is considered. The surgical approach is to remove the damaged fibers of tendon and if necessary supplement or reinforce it with a nearby tendon. When the inflammation occurs at the location where the tendon inserts into bone, the treatment is almost identical but if the problem is chronic enough there can be spur formation (which is what Floyd cited as the problem yesterday), which usually takes years to develop. It is not the spur that is painful but the inflamed tendon adjacent to the spur that is the source of the pain. Treated surgically, the tendon is split, the spur is removed and sometimes the tendon needs to be reinforced with a graft of supplemental adjacent tendon. Recovery can take 3 months or more. So, hopefully, Jim Hendry and his medical staff are doing some serious medical homework if they really expect to get more than 97 games and 332 at bats like the Mets got from Floyd last season. Well, maybe that’s the point(keep your expectations low), one Matt Murton just might be thinking. Welcome to the Chicago National League entry, Mr. Floyd, where we are no strangers to the disabled list either.
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Comments

Fantastic article, Cubster.

thank goodness for the "river styx clause" in his contract, just in case...

I look forward to more of your articles throughout the year, cubster. Since you mentioned him, how about more on Mark Prior.

I thought you said Prior suffered from vaginitis not tendonitis--
Implying Prior's problems aren't physical at all. And while that criticism used to make some sense to me back when he and the Cubs were denying he had a shoulder injury, it no longer does now that it turns out the denials were just some of Dusty Baker's patented "strategery" .

So, since you've been so hard on Mark P, how about explaining why you feel that way.

"I thought you said Prior suffered from vaginitis not tendonitis–"

CWTP: I believe you may be thinking of "SILENT (not really) TOWEL" on the vaginitis crap.

CUBSTER: Cool. Many thanks on the insightful med angles.

thanks to all the contributors lately...cubster, manny, dying cub fan, all the gangsta rappers, jesus, my mom, and my agent for believing in me.

btw...it seems the 08 option on floyd is for 10m...so, well...unless he's playing LF full time by the time 07 is wrapping up its doubtful he's gonna steal murton's playing time too severely unless he's already "won" the 08 job as the season progresses (unless he's injured or outplaying his 10m worth and someone doesnt wanna match the mutual option).

not sure whether the contract is for 10m next year, but it looks that way from everything written so far.

heh...mr. groper has been replaced on the Little League WS coverage on ESPN by mr. dustbag.

he got a "stone deal"...covers 10 games a year plus some analyst work and possible postseason work in addition to his LLWS commitment.

CUBSTER: Like E-MAN and CWtP, I too look forward to your articles--your MANY articles--over the coming months and years.

I guess you know you will probably have to give up your practice, since TCR demands absolute loyalty and your 100% attention, even as a so-called "Guest Commentator." Also remember to send Ruz, Rob G, Trans, and myself 25% of your earnings. And make sure it's CASH (U. S. currency only). We do not accept personal checks, cashier's checks, or credit cards. You will be provided with a list of P. O. boxes, dummy corporations, and drop sites each of us use at a later date. 

Hopefully Ruz, Rob G, Trans, and I will be able to get an occasional article posted edgewise between your daily or twice-a-day medical reports and analyses, but considering the history, mystery, and frequency of Cubs injuries, I believe we will soon be changing the name of this site from "TCR" to "CUBSTER, M. D." And I personally think that would be a good thing.

cubster....great work, as everyone else has already said. i look forward to more of your articles!

Likewise, looking forward to more good stuff, including long laborious and painful description of Cubster's resulting carpel tunnel syndrome. What's the over/under on when this happens?

...hurts...while...typing...this....ugh.

re:#4

Yeah, ST should be selling ointment or something. He's beaten the Ms. Prior thing to death his towel. But I was referring to comments by cubster the last few months along a similar line.

Here's cubster about Prior recently,

http://mvn.com/mlb-cubs/?comments_popup=57#co...

Thanks all for the warm reception...knowing how things go I'm hopeful that the glow lasts longer than the goodwill Neifi got from his HR as a Rockie back in 1998.

Sure, Carpal Tunnel and Z; subscapular tendonitis, congenital shoulder laxity (the diagnosis of the moment) and Prior; Torn menisci, Tommy John surgery, Labral tears and Kerry Wood; torn flexor tendons and Sean Marshall (and I think Sean Gallagher) have experienced and I hope there aren't enough injuries for Phil's proposed twice a day reports. Bruce Levine, I'm not...

Az Phil...didn't they tell you that part of my deal is that you now have to scout my 21 yr old son, Ken. College Jr. at Case in Cleveland. He was a catcher in T-ball as I recall.

CWTP...just one thing, remember never to ask your orthopod for advice on vaginitis, cause it isn't in our curriculum. Orthopods aren't very good on psychosomatic stuff either. If it isn't in the skeleton we're not going to be very useful. Calling Prior a wuss, now that's done while wearing my Cub fan gear not my scrub suit.

Speaking about injuries, Anibal Sanchez just went in for an MRI on his right shoulder. It revealed nothing serious supposedly, but how many times have we heard that? Guess we can now add Girardi to the young arm killer list (just joking)...:)

The Mark Prior Society chimes in with scathing rebuke over my opinion of the man. Lovely. Tell you what. Let's keep pinning our hopes on Prior overcoming his 1,300 medical and psychological maladies to be an effective pitcher. That strategy has worked SO brilliantly for Jim Hendry the past three seasons, so why not one more. Maybe Prior can get his millionaire daddy to take a break from sipping cognac poolside at the Prior family estate in Southern California to speak to the media on behalf of his soon again. He'll probably tell us that Mark cut his toenails too close and therefore will sit out the 2007 season for fear of getting a nasty case of gettin a nasty infection. Meanwhile he'll have no problem cashing the $3.5 million check from the Cubs.

Prior sucks. And like 90% of diehard Cub fans, I make NO apologies for questioning his injuries and his heart.

Silent Towel:
"Prior sucks."

I wouldn't say that. I would say that he is clearly injury prone. Funny, I remember getting killed for calling Prior injury prone 2 years ago by John Hill. My, my how things have changed.

Good to have you in your new role Cubster.

I often wonder what the hell these injuries mean in laymen terms, such as the long-term likelihood of success via rehab vs. surgery, etc.

Hopefully you can also give us some more realistic timetables than our good buddy Mark O'Neal.

Believe it or not, there's a middle ground between believing that Prior is a savior (which nobody, as far as I can see, is doing) and shitting out an endless stream sophomoric and misogynistic bile (that's you).

"The Mark Prior Society chimes in with scathing rebuke over my opinion of the man."

well, your opinion contains no basis of fact other than your gut feeling. people are supposed to take your gut feeling as fact in order to work on your level of handicapping the season and you refuse to look outside of your outlook even though there's no current basis for it even being in the realm.

Manny, I wouldn't call him injury prone as we have yet to know what injury has kept him form pitching. I don't call being a wimp injury prone.

Trot Nixon = $3M per year
Cliff Floyd = $3M per year

I think we chased the wrong man.

Well first, if you read Miles article and it was kind of known before that, Gary Hughes and Hendry have quite a history with Floyd.

But Nixon has also been in a nice, steady decline with quite an injury history. Check out his fangraph and look at his RC/27 and ISO

http://www.fangraphs.com/graphs.aspx?playerid...

Yeah, that OBP is nice and his D is a little better, but who knows if he would agree to the same role Floyd would? As far as I know, he's going to get more playing time in Cleveland than Floyd looks to as a Cub.

Believe it or not, Mark Prior did pitch last year.

Poorly -- as he battled through rotator cuff tendinitis and resultant injuries listed as shoulder, oblique, side, shoulder again...and again..

Strange to some, he was sent to orthopedists for treatment.

I'd say he's got a shoulder problem, which as our resident experts aver shouldn't bother him at all. Thus he's a wimp to some, injury prone to others. A mental case, or an insurance case.

As for me, I'm encouraged to hear he's been throwing off a mound with no ill effects this winter. Compare that with last year's preseason reports. Things are really looking up. We may actually see both Prior and Wood pitching in spring training this year!

rob g, i agree with your comments about nixon's parralleling floyd's decline. the one thing that makes Nixon unique to the cubs is that HE PLAYS RF.

DUSTY BAKER SIGNS

with ESPN to do the Little League World Series

http://www.newsday.com/sports/baseball/mets/c...

I saw your comments in the other thread MD hater, but Jones is still here and I know people can't get the image of him rifling throws two feet in front of him out of their head, but he WAS an above average defensive right fielder last year by most measures.

The dude can chase a flyball down just fine and he's absolutely fearless going into the corners and foul territory of the very treacherous right field at Wrigley.

Our outfield defense was rated quite highly by a lot of people who study it objectively and so far the only difference is Soriano versus Pierre. We'll see how that plays out as Pierre had a fine season with the glove last year and Soriano (if he plays CF) will be learning a new position, but he certainly has the athletic skills to handle it. And CF at Wrigley isn't that hard a place to play, it's relatively small and you just have to not kill yourself on the bricks...

CWTP...I agree with your comment on post #22. It's a good sign if he is actually throwing from a mound at this point. Last spring training they said Prior was fine but right from the get go Rothschild had him on some funky slowly progressive program that wasn't going to have him throw off a mound for a few additional weeks, so by the time he actually threw off the mound they said he was OK and then almost immediately said he had a shoulder problem. He was obviously injured from the begining but nobody was talking factually. Back then I asked one of the WSox team docs (who is a shoulder specialist), that I ran into at a course, about any gossip about MP, but he hadn't heard anything. Also remember the stuff about his winter viral illness that weakened him. I thought he might have some medical condition that was going to need chronic medication but that was just my speculation from reading between the lines (based on persisting weakness after some viral problem) and I haven't seen anything to lead me in that direction since. My thinking was in the direction the Matt Clement asthma problem, where some of the medications have significant side effects to joints, which I never heard when he was a Cub but it came out during his Red Sox first year. Going from one weakness (Achilles) to another ala Sampson...should we also tell his barber to be less aggressive on his haircuts?

No offense to Cubster, but acupuncture is a great modality for sports folk, and I wonder why it isn't used more often. Western medicine is great for ambulatory or trauma-related injury, and pretty much sucks for chronic stuff, which acupuncture excels at.

Rob, agree on the catching the ball aspect of the business. however, i see teams taking advantage of our outfield arms. i'd much prefer seeign a guy with a good arm in right to prevent that. granted, soriano should be work in progress, but at least he prevents the oposing team from putting a ton of pressure on our defense. Jacque in right and murton / floyd in left provide other teams the opportunity to be real aggressive on the bases.

eventually, pie in cf and soriano in right should be an upgrade, whenever that happens. however, i'm really not sure how strong soriano's arm is - the fact is he had a great amount of assists last year because oposing teams challenged him.

teams don't run on Jones every chance they get, his arm is strong enough to at least make you think twice, even though they probably should run cause he'll likely never get it to where it should go.

I've harped on the arms before as well, but I've read enough articles this offseason that have convinced me that we're way overvaluing their effect. It's far more important to get to the ball....

but acupuncture is a great modality for sports folk
-----
I tried to limit the scope of the article, not intending to make it a medical thesis. Acupuncture has a role as a alternative rx, basically it does no harm so why not try when other things aren't working.

One of the newer things for achilles tendonitis not responding to basic stuff is the ultrasonic shock wave therapy. It's expensive though. The device is similar to what is used to break up kidney stones but is used to disrupt the damaged tendon and stimulate new blood supply which theoretically brings in cells that lead to healing. It was used on Magglio Ordonez for his knee problem which was reported to be avascular necrosis (damaged blood supply locally to bone in the knee). There is not much solid data on it's use for what Ordonez had and that's why he had to go to Vienna, Austria to get it done. There is more data of it's use on plantar fascitis, patellar and achilles tendonitis, and it has a role these days as an alternative before surgery.

I too appreciate the article.

I must say though, I am a bit disappointed at being left out. With all of these guest contributors and new additions, I, it seems, have been overlooked. AZ Phil was added when his superior knowledge of minor league baseball et al was discovered. Cubster can provide relevant information about medical issues. This is all wonderful, but my education in bible, religion, and theology is going to waste. I can provide insight into such topics as "what does God think of baseball?" and "what does the bible say about the Cubs?".

In the meantime, I'll bide my time reading all of these wonderful articles written by other people.

my acupuncture story...

The Angelfan wife and I decided we wanted kids because we hated having free time and money (sarcasm). So after trying for a good 9 months with no luck, someone suggested we try acupuncture as they claimed it worked for them and they have 2 lovely daughters. So we tried it and we're sitting in the doctor's office waiting and looking around and we notice all the pictures on the wall of the women she's helped:

Me: Wow, look at all those twins, we sure about this?
Wife: Um, yeah, we can't even have one, don't worry about it.
Me: Okay, but that's a lot of twins...

Fast forward two months of bi-weekly treatments, some of which they attach electrodes to the needles btw and the wife gets knocked up and lo and behold...TWINS!!!

Now to be fair, we of course were also seeing our regular OBGYN and around the same time, she started prescribing us some fertility drugs, so who knows which one worked. But we like to credit one for Western medicine and one for Eastern medicine.

And a good acupuncturist will refer you to Western medicine when appropriate. I had a nasty staph infection, the kind the athletes are getting, and an acupuncturist told me if I didn't go see a medical doctor I'd lose my foot.

I went.

The Joe...i have you beat - I have an education in bible, religion, and theology, along with having further education in Sociology.

Maybe we should get together and write long treatises on the social engagement of baseball teams and how it relates to ones' spiritual quest! We can throw in some good analysis of the income inequality between major league players and minor leagues for good measure.

the acupuncturist was also a fully licensed OBGYN here in the States I should add. She certainly wasn't a hack, or at least she charged us like she wasn't a hack.

I even think acupuncture is being covered by some insurances now...

Re: Jacque Jones

Jacque Blacque Schlaque is an asset to the Cubs. He's signed to a good contract and is a quality, proven run producer. He also adds a much needed element of athletcism and speed to the table. If you ignore his wretched throwing ability, he actually is the best right fielder the Cubs have had since the days of Andre Dawson. I'll take what he brings to the table any day of the week.

Just a heads up, Cliff Floyd is going to be on Mike & the Mad Dog on WFAN in NY in a little while. I will give a quick recap after the interview is over.

dont think anyone ever complained about sosa's arm for most of the 90s and his glove wasnt bad.

the 00's sosa that lost a step to his bulk and wear/tear wasnt the sosa that everyone got to know.

Ha! Bring it on.
BA: Bible, Religion, AND PHILOSOPHY;
MATS: Biblical Studies.

Sociology is probably more relevant than philosophy to baseball studes, though.

I like your ideas. I also wanted to mention earlier, that I like your website.

I complained about Sosa's arm all the time.

He had an incredibly strong arm, but rarely hit the guy he was trying to throw to. He rarely hit the proper cut-off man and often completely missed his target.

On top of that, he took really bad routes to balls.

Especially considering his speed and athleticism, his defense was significantly lacking.

The Joe...well, you have me beat if you are a philosopher. But thanks for liking my site. I spend WAY too much time on it!

Is the Menno Simons site yours? Or just a site you link to?

No it's mine. Though I didn't consider one key fact when I made it...Mennonites don't spend money.

A BA in philosophy doesn't make me a philosopher...just a guy who values his own opinion too highly.

if a tree falls in a forest and no one is around to hear it is it still dusty's fault?

that's deep...deep like a hole.

I have a question for The Joe and dave. Why does God hate the Cubs?

I have a question for The Joe and dave. Why does God hate the Cubs?

Haha...I wish I knew.

Omar Minaya is on Mike and the Mad Dog on WFAN right now and he just admitted he posted $39 million for Matusaka. And he said from what he heard he was 2nd with NYY 3rd.

"Now to be fair, we of course were also seeing our regular OBGYN and around the same time, she started prescribing us some fertility drugs, so who knows which one worked. But we like to credit one for Western medicine and one for Eastern medicine."

Rob, I think the SoCal sun has cooked your brain. You're wife was taking fertility drugs and you credit your children to voodoo needles?

MANNY:

Did you hear the CFloyd interview?

Very interesting career splits for Floyd.

.274 w/2 outs RISP

http://www.baseball-reference.com/pi/bsplit.c...

Certainly, as gravy to what we have in the outfield, that's great. But no regular platooning, in my opinion.

E-man-
I never heard it. They talked to Minaya and Randolph, and I thought they were going to talk to Floyd too. So either I missed it or they were talking about those other two. Not sure...

Yeah, Rusch is gone!

Rob, I think the SoCal sun has cooked your brain. You’re wife was taking fertility drugs and you credit your children to voodoo needles?

Just one of them.....

the friend who gave us the tip though and was in a similar situation did not use fertility drugs, just the acupuncturist. Now they only had one kid at a time, but whatever.

MANNY: If you were working, and distracted, then you better check your priorities buddy!

I DONT EVEN WANT TO KNOW where the acupunturist inserts the needles for fertility treatment. *thanks so much* for that mental picture.

Back to baseball, can we entertain a round of "The Cynicism of You" and have some information about who, contractually, is due to have a "good" [read, self-serving] year, if they are really just slacking off until they need to juice their numbers for their next fat contract? I'm just sayin'...

"Just one of them….."

BA-ZING!

Hey, boys, there's a two drink minimum today!

haha dave in pitt, it was odd, lots in the belly area, fingers, wrist, top of the head, ankle and feet, but none in the private regions.

Cubster,
I thought Ordonez had microfracture surgery. I'm a physical therapist that works for the company that sponsors the White Sox and many other Chicago sports teams. I heard before his surgery he could not weight bear at all on one leg (therapist that treated him). Anyway, do you specialize at all? I have seen one Achilles tendonitis repair from Dr. Toolan at U of C. She's doing great, so I'm confident in Floyd (sign of things to come I guess).

"Why does God hate the Cubs?" Here is an extremely late response to this question.

Sometime, in the late 19th/early 20th century God was in Heaven boasting about how great Cub fans were. God said to Satan, "Have you seen these fans? They're the best in the world."

Satan challenged God: "Of course they're great, but that's because the Cubs are so good. Take away your blessing and let the Cubs suck. Then we'll see how good of fans they are."

God said, "Very well. I give the Cubs over to you. Make them as pitiful, as Dustiful, as College of Coach-ed, as Alex Gonzales-ed, and as cursed as you can. After that amount of time, we shall see how good these fans really are."

For 100 hundred years, the Devil has been running the Cubs into the ground over a wager. He has often taken human form (as a manager, GM, player, et cetera) and sometimes in the form of a goat (the common symbol for Satan).

The moral is that God doesn't favor the prosperous, nor hate the suffering. Sometimes, God is just gambling with the universe for the hell of it.

Dare I say, "Comment of the Day"?

The Joe, don't steal my thunder. We are Job is my schtick.

My sincerest apologies, Chad. I wasn't aware that I was stepping on your toes.

I change it to another suffering biblical hero...there are plenty to choose from.

SO glad to have you with us, Cubster. And I'm so much smarter upon having read that article, than I was before reading it. Awesome, thanks!

Can God create a franchise so bad that even He cannot improve it?

The problem here Joe, is that I cannot search past posts from pre-merger. I wrote a whole thing about it.

Dare I say, “Comment of the Day”?

Comment of the year! See...he was a philosophy major, I was just a Bible/Leadership major...

#65:See…he was a philosophy major, I was just a Bible/Leadership major…

...and I was a Classical Greek major, which is why I was stoked when Cubster was dropping some science about Achilles and Thetis.

I think a strong case can be made that it's not the Judeo-Christian God who is constantly messing with the Cubs, but the Mount Olympus crew. They were much more mischievous and their cruelty was much more the whimsical, pointless variety that we Cub fans know so well. Game 6 was Sophocles in cleats; Odysseus would totally recognize Hawkins-to-Jose-Offerman's-helmet as typical Olympian BS.

Thus ends the only time I have actually put that part of my degree to use since I got it.

I heard before his surgery he could not weight bear at all on one leg (therapist that treated him). Anyway, do you specialize at all?
-----------------
MerigoldBowling...Merigold (on Grace) was my favorite bowling lanes when I was growing up!

I don't believe Ordonez had microfx surgery which is used for chondral defects. His problem was avascular necrosis(AVN) in the knee which shouldn't produce a chondral defect, it potentially involves the whole condyle...osteochondritis dessicans is possibly what you were confusing it with? The latter produces an avascular lesion of bone and cartilage in the knee, but is more focal than AVN. Usually the lesion is a cm in size and can be loose or hinged. These can be either excised or fix back in place depending on how large and what location the lesion is in.

I have special interests in joint replacement surgery but my practice covers most areas of ortho and I have partners who cover spine and hand surgery.

Cubster- Any comments on ACL surgery?

I tore mine years ago and never got it fixed....should i get this done?

DB: I tore mine years ago and never got it fixed….should i get this done?

I'll save writing in detail about ACL injuries until we see Eric Patterson and rehash the bad ol days with K-Pat who had his ACL reconstructed.

It depends on your symptoms. When the ACL is torn only 1/3 of patients get significant instability. It depends on what activities including athletic stuff you do to provoke symptoms. Often you can have a meniscus tear with the ACL injury and that can be the souce of problems, not the ACL. So it's a more complex decision as to reconstructing the ACL. The ACL doesn't heal well when torn or even stitched together so direct repairs have been abandoned in favor of several reconstructive options involving different graft options such as patellar tendon or hamstrings. Autograft means the graft is selected from the patient which is the safest approach but there are cadaver (Allograft) graft choices as well...just hope your "donor" is disease free as thats the controversy for that type of graft.

cool...thanks cubster....i wouldn't usually solicit advice.

Many people suffer because of diagnosis incorrectly put initially why that physicians do not hurry to recognize the fault, whether there are the successful judicial claims, won by patients? Where about it is possible to esteem? WBR LeoP

Is the Chlamydia trachomatis most common reportable infection in the US? WBR LeoP

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