With the beginning of spring training, the bitter memories of the end of last season are finally beginning to fade. Our hope of another parade down Broad Street is renewed with each pitch from Cliff Lee, Doc and Vanimal. The big concern with the end of last season and continuing with this season is the cold bats when a simple hit is needed. The big question is whether Ryan Howard will be back to his great form following his Achilles rupture and repair. They are forecasting that he should only miss about 1 month of the season, but what can we expect from him when he returns?
Well to answer that question you have to understand what causes a tendon to rupture and what is involved in the repair. A healthy tendon does not rupture unless their is direct injury. Only tendons with damage can rupture. It occurs when the tendon is contracted and the foot is pushed up as with a sudden acceleration. The tendon tears at it most vulnerable area where the blood supply if the least. The tendon tears across either partially or completely. When a complete tear occurs surgery is often required. The tendon can be repaired end to end (the torn ends repaired) or sometimes a graft is needed to span the gap if the tendon is in poor quality or the repair was delayed. The post operative course requires non weight bearing for 4-6 weeks while the tendon heals. The foot is placed in a pointed position. Over time as the tendon heals the foot is placed in a more flexed position. The rehabilitation process includes stretching the newly healed tendon, as well as, restrengthening the muscles wasted by being non weight bearing for so long. This process can take many many months.
No recent articles have been published in regards to returning to professional baseball after an achilles rupture but last year one was published in March of 2011 by Khalid Shirzad, MD; John D. Hewitt, MD; Carter Kiesau, MD; and Selene G. Parekh, MD, MBA in Lower Extremity Review of football players returning after achilles rutpures. They reviewed 31 Achilles tendon ruptures in NFL players over a five-year period (5.2 injuries/year). "During the 2008-2009 NFL season, six players suffered season-ending Achilles tendon ruptures. Although the incidence of Achilles rupture is low, 0.93% per NFL game, nearly 36% of affected players never return to playing at the NFL level. Of the 31 players who sustained an Achilles tendon rupture, 21 (64%) returned to play in the NFL at an average of 11 months after injury. In the three seasons following their return, those 21 players saw significant decreases in games played and power ratings compared to the three seasons preceding the injury."
Although this does not bode well for our hopes of Ryan Howard returning to his prior greatness maybe what he lack in speed and power can be made up for at the plate. It certainly was encouraging to see him running without laboring and fielding ground balls yesterday at the Phillies Spring Training facility in Clearwater, FL (see picture below). Either way, I will be glued to my TV to find out come April 5th.
Dr. Alexandra "Sandie" Grulke
http://www.podiatrycarespecialists.com/
