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April 22, 2011

Collateral Damage

Lisfrancly Speaking

by Corey Dawkins and Marc Normandin

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There is a reason we discussed concussions in baseball and the importance of the brand new 7-day DL this week. As we mentioned, people don’t always consider baseball a sport in which concussions occur often, but just a handful of weeks into the 2011 season, we have already seen concussions strike two victims: Yunel Escobar, and now Eric Hurley (as well as a minor concussion Josh Beckett dealt with during spring training).

Logan Morrison, FLO (Lisfranc sprain left foot)
Logan Morrison can feel Barry Zito's pain. While we are not quite sure exactly which ligaments were damaged in Zito's foot, we do know at least one spot that Morrison injured. Lisfranc injuries occur in the midfoot, where several bones meet to help support the body's weight during activities (especially when going up on the toes).

The Lisfranc joint is a bunch of small bones that form an arch from the inside to the outside of the foot. From these smaller bones, long bones (metatarsals) extend down towards the toes. The second metatarsal–the one next to the big toe–is slightly longer, which helps to stabilize the foot but also puts it at risk of injury. All of these bones are joined through various ligaments and connective tissue, but the first and second metatarsals really don't have much holding them together directly. The Lisfranc joint is composed of the first and second metatarsals and one of the small bones in the arch of the foot called the medial cuneiform

The Lisfranc can be injured through several mechanisms. In everyday life, injury often occurs by dropping something heavy onto the top of the foot. In athletics, injury commonly occurs through a forced twisting of the midfoot, or having someone land on a player's heel when all of his weight is on the ball of the foot. Often diagnosed as a mild mid-foot sprain, it can also involve a fracture and/or dislocation.

This type of injury can be difficult to diagnose initially, as it often fails to show up on normal x-rays. X-rays need to be taken while the patient is standing up to best visualize the joint's instability. If the injury is severe enough, it can be seen on plain x-rays, but that isn't the case for most athletes. Examples that extreme are usually seen in high-energy collisions, such as motor vehicle accidents.

In mild cases, immobilization via cast is required to allow the area to heal, usually for about three to six weeks. Physical therapy and shoe inserts follow. If the area is unstable, surgical stabilization is generally required. A surgical screw or pins are inserted, and then the area is immobilized for about six to eight weeks. Some therapy is performed, and if sufficient healing occurs, the screw or pin is then removed in a second surgery. This process generally keeps the athlete out of commission for at least three to four months. If the injured player come back too early, he or she risks permanent damage to the nerve and blood vessels in the area, not to mention an increased chance of developing severe arthritis.

That leads us back to Logan Morrison. So far it seems that his case is a mild one. In roughly two to four weeks he will have his cast removed, and his foot will be reexamined. If there is still displacement between the bones, they may be immobilized for several more weeks in an effort to avoid surgery. If surgery is recommended sooner rather than later, it will most likely be late July at the absolute earliest before we see him again. In the meantime, you can still read his tweets.

Geoff Blum, ARI (Right knee surgery)
Blum didn't have surgery yet, but his troublesome knee will go under the knife sometime soon. There has not been a clear explanation as to what ailment his surgeon will be addressing, since the cause of his discomfort has not been discovered.

Kevin Towers admitted that the surgery will be more exploratory than anything else, although the operation will address any loose cartilage or fraying within the knee. Microfracture surgery was ruled out in spring training, but that may be reconsidered once Blum's surgeon goes in and takes a look around. Blum is expected to miss six to eight weeks, but that time frame will remain uncertain until the root of his trouble is ascertained.

Eric Hurley, TEX (Skull fracture and moderate concussion)
Yes, we know that headgear has been developed to protect pitchers, and yes, we know major-league pitchers won't wear any of it anytime soon. That doesn't change the need part of the equation. Eric Hurley is the latest victim of a batted ball, which caught him just right (or, you know, wrong—he was struck, after all). He was hit directly above the temple and suffered a minor skull fracture and moderate concussion. Scarily enough, he got off lucky.

It's probably going to be a while before we see Hurley on the mound again. That's sad to say, given that he missed the 2009 and 2010 seasons due to surgery on his torn rotator cuff, but at least he will be able to return at all after taking a liner to the head.

Flesh Wounds: The MRI on Aaron Hill's hamstring was inconclusive, but he is still off the field. There is no definitive timetable for his return... Dallas Braden's MRI showed no structural damage, so he will take some time to decrease the inflammation in his left shoulder... We won't be seeing Joel Zumaya soon, as he chose six weeks of rehabilitation over surgery. If his elbow doesn't improve, he will go under the knife at that time... Angel Pagan pulled a muscle in his side and will be reevaluated today... Nyjer Morgan's deep thigh bruise has put him on the 15-day disabled list.

Corey Dawkins is an author of Baseball Prospectus. 
Click here to see Corey's other articles. You can contact Corey by clicking here

Related Content:  Logan Morrison,  Surgery

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