The newest addition to the Cubs pitching staff, 37 year old (38 on April 2nd) Jon Lieber is apparently ready to pitch. His tenure in Philadelphia ended abruptly last season in the 6th inning, on June 20th, while backing up home plate on a play in Cleveland. It was one rotten day for him already as he had given up 7 runs on 10 hits and was on the hook for his 6th loss. Initially, and at least for the first few days, it didn’t look like anything serious, probably just the run of the mill lateral ankle sprain.

This was the initial report from the Phillies site:

June 21st: Ken Mandel, of, reports Phillies SP Jon Lieber (ankle) injured his right ankle Wednesday, June 20, while backing up home plate. Lieber had the ankle checked out and it turned out to be largely a muscular injury. Because of off-days, the Phillies should be able to give him extra time to heal and he won't be needed until Friday, June 29, at the earliest.

Mirroring this information, Will Carroll, from Baseball Prospectus, in his Under the Knife column on 6/22/07 said:

The Phillies are also waiting to see how Jon Lieber responds after spraining his ankle in Wednesday's start. He limped off the field after rolling the ankle running to back up home plate after a hit. It didn't look serious, but we should know more by the time his bullpen session comes up this weekend.

Day three injury update:

June 23: Ken Mandel, of, reports Phillies SP Jon Lieber (ankle) had his ankle wrapped Friday, June 22, however, he is still expected to make his next start Wednesday, June 27.

Now we know that this was no conventional ankle sprain.

Lieber apparently was having some problems with his foot starting the first week in March in spring training (per a C. Muskat interview this year). Older pitchers expect to have a lot of aches and pains. Apparently it wasn’t enough of a nuisance to get an MRI at the time. Still, it certainly could have been that Lieber's foot was giving him some soreness at the start of the season with the tendon having degeneration, inflammation or wear problems and it finally ruptured with the June 20th injury.

Looking at Lieber’s last 5 starts with the Phillies, four were awful, including three-10 hit outings each over 5 innings and one 13 hit outing over 6.2 innings. Nobody was blaming those outings on a inflamed foot tendon and it must not have been overly obvious as in the midst of that ugly string on June 9th, he did throw a beautiful complete game 3 hit shutout against the Royals.

With an acute injury in Cleveland and significant swelling, MRI imaging of the foot/ankle was obtained and it showed that the injury was something fairly uncommon. He had a rupture of the peroneus longus tendon, well below the outside of the ankle as the tendon goes toward the bottom of the foot.

Then, after the Phillies team orthopedist evaluation, came second opinions by sub-specialty trained foot and ankle orthopedic surgeons.

Finally, USA Today reported:

AP--Jon Lieber will undergo season-ending surgery on Friday (July 6th) to repair a ruptured tendon in his foot.

Lieber was 3-6 with a 4.73 ERA in 12 starts this season. He was the Phillies' opening-day starter in 2005 and '06, but will become a free agent after this season. "He pitched some good baseball for us," said Phillies manager Charlie Manuel. "If things had been a little bit different, he could've pitched better. He had the talent." Lieber will have the surgery at the Mercy Medical Center in Baltimore, the team said.

Jon Lieber had his peroneal tendon repair surgery on July 6th at Mercy Medical Center in Baltimore, The head of this center's foot and ankle department is Dr. Mark Myerson, who is one of the most renown foot and ankle surgeons and who apparently trained the Phillies local foot and ankle specialist (Dr. Steven Raiken). We are talking high end orthopedic sub-specialists here (their practices focus only on foot & ankle care). I'm not sure which surgeon did the tendon repair but it appears he was in very good hands.

More newswire stuff:

Philadelphia Phillies SP Jon Lieber (foot) had successful surgery, Friday, July 6, to reattach a tendon in his right foot, according to the Associated Press. He'll be in a walking boot for three to four weeks.

Sat, 14 Jul: Phillies | Lieber moved to 60-day disabled list

Tue, 7 Aug 2007: Phillies | Lieber cleared to begin rehab program

Finally, from C. Muskat, at the site:

Lieber…finished his rehab in early October. Now, he said, everything is fine, and Lieber is back on his normal off season routine.

From my perspective as an orthopedic surgeon, this was an injury I had to do some literature review to learn more, as I haven’t seen an isolated peroneal longus rupture. I've read the chapter in Dr. Myerson's textbook. I’ve seen and treated many peroneal tendon subluxations (partial dislocations) where the two peroneal tendons (longus and brevis) slip around the injured or stretched retinaculum that supports these tendons just behind the ankle. That situation was the infamous “bloody sock” injury that Curt Schilling had back during the 2004 World Series. Schilling’s memorable treatment was very unconventional as the former Red Sox team physician, Dr. William Morgan, put stitches through the skin deep enough to stabilize the slipping tendons as a temporary measure to get him through the playoffs. In the offseason, he had more definitive reconstruction of the injury.

Here is a link to the anatomy of the outside of the ankle/foot.

The peroneus brevis tendon attaches to the base of the 5th metatarsal and is responsible for eversion (outward rotation) of the foot. The longus tendon goes under the foot and ultimately attaches to the undersurface of the 1st metatarsal. This stabilizes the 1st metatarsal and foot from rolling over in both push off and landing, so it’s function is very important in pitching from a mound.

Lieber’s injury was a bit lower down (distal) into the outside portion of the hind foot, well below the ankle. I could see why there might be a delay in diagnosis and confusion with a conventional ankle sprain which is a lateral ligament injury (ligaments between the fibula and talus/calcaneus and tibia). Lateral ankle sprains will look similar to this injury with lateral ankle and foot swelling and an X-Ray that doesn't show a fracture. For most ankle injuries, it’s conventional to get X-Rays to make sure there is no fracture. MRI’s are usually not ordered unless the ankle sprain is taking too long to heal. Most severe lateral ankle sprains take 2-6 weeks to heal. In Lieber’s case, the correct diagnosis was made very quickly. So getting the MRI early on meant Lieber’s swelling and tenderness initially didn’t match up to where a typical ankle sprain should have been tender. Score one for the Phillies athletic trainer and Orthopod showing excellent clinical decision making, a very fine job indeed!

In the case of a peroneal longus tendon rupture, there is a tunnel/groove in the outer hind foot, which involves the cuboid bone where the peroneal longus tendon passes and often there is a spur or small (sesmoid) bone that can lead to friction and subsequent tendon rupture. One of the larger published series I found on this had only 41 patients of which only 11 patients had isolated peroneal longus rupture as Lieber had. So it’s a pretty rare (or at least not commonly diagnosed) injury. In the days before MRI scans (the early 1980’s) this injury had virtually not been reported on in the ortho literature. Also, I couldn’t find any previously treated professional pitchers with this injury, but the orthopedic literature suggests athletic patients do well when the tendon rupture is surgically repaired.

Thus, if you see Derrick Lee backing up the catcher on throws from the outfield when Jon Lieber is pitching, you’ll be a bit more understanding. That is, unless Jon Lieber has already let in 7 runs by the 6th inning.


Recent comments

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  • Except that he gave up Russell and McKinney for a half-season of Hammel...

  • Beane cam at least point and laugh at Hammel.

  • The genius Angelo traded Olsen at Martzs request

  • Maybe Theo will sign Shark just so he can call Billy Beane and say: "Let's see...Russell? Check. McKinney? Check. Hammel? Check. Ninja? Check. Any other deals?"

  • To be fair to Emery and Trestman the foreshadowing of last year started happening well before them with the failure or mismanaging of multiple draft classes forcing the team to overspend in a free agency market that is even worse than baseball. Kyle Long seems like a good pick but they traded away another good one in Olson because of Martz's stupidity and inability to change his offense to fit the team talent.

  • HAGSAG: I think Domonic Brown does fit the criteria of a reclamation project, but unless he is willing to accept a minor league contract with an NRI to Spring Training, I don't think the Cubs would be interested given where the Cubs are right now. A couple of years ago? Yes. But probably not now.

    Brown would be better-off going to a club that is rebuilding and re-establish his value there, like Chris Coghlan did with the Cubs. And if he can re-establish his value, he could get traded to a contender at the trade deadline and take it from there.  

  • "they just fade away"

    (Except in the cases of no-fade lefties like Moyer, Orosco and Rich Hill.)

  • Amazing to me how quickly it fell apart under Trestman. Year 1, they were a Chris Conte brain fart away from making the playoffs. Year 2 -- coach, staff and GM all fired.

  • I am sure Jonathon Mota will be signed next.

  • AZ Phil, what is your thoughts on Domonic Brown as a reclamation project?

  • He also played LF in deference to Curtis Granderson.

    Meh... other moves to make...hope to see a move or two soon.

  • I haven't seen much Bears football this year - difficult to watch the games out here, but the game I saw the week before I was watching in shock as I saw them actually make tackles. And Cutler has looked really good, too.

    I guess people can quibble about play calling, but the team I saw is way more than 50% better coached (my only very minor disagreement with your comment).

    Under Trestman, the team didn't do anything right. This team played like a well coached team when I saw them play the Rams.

  • "What is sometimes overlooked about Vogelbach because of his "bad body" and because he has struggled so much defensively is that he is a hard worker, has a great attitude, loves to play the game, and is very well-liked by his teammates, and while that may not seem important, teams do actually value stuff like that. "

    As well they should. Replace a word here and there and you are describing any worker someone would hire.

  • Hak-Ju Lee signs a minor league contract with SF Giants.

    Some closure on the 6 degrees of Separation for Matt Garza/Chris Archer

  • Hahahahaha

  • -0.3 WAR in 7.1ip last year...

    -3 WAR projected over the course of a season.

    the cubs just added an all-star reliever's worth of work by losing b.schlitter.