Boston Red Sox Lose Pedroia with a Foot Fracture
Dustin Pedroia fouled a ball off of his left foot on Friday night, leaving the game with a limp and a walking boot. Initial xrays did not show a break, but later studies showed a break or fracture of the navicular bone of the foot. The good news is that the fracture is non-displaced (did not shift), but the bad news is the fact that this bone, the navicular broke.
(See a video of the injury at http://mlb.mlb.com/news/article.jsp?ymd=20100626&content_id=11614582&vkey=news_mlb&fext=.jsp&c_id=mlb)
The navicular bone of the foot lives in the inner middle part of the foot. It is an exceptional bone in that it does not have a great blood supply. This bone interacts with four to five other bone of the foot, which leaves little room for blood vessels to enter the bone. Furthermore, two major tendons attach to this bone, using the bone as a lever arm to move the foot. Through these tendons, the navicular plays an important role in maintaining the arch of the foot.
The navicular bone can have a variety of different breaks or fractures: a cortical avulsion fracture (small sliver of bone breaks off of the navicular), a tuberosity fracture (a break of the attachment site of one of the major tendons), a body fracture through the navicular, and a stress fracture (the most common injury to this bone). Pedroia’s break, from initial reports, appears to be a break through the body of the navicular bone. These breaks usually occur with direct trauma on this bone, as in the case of Pedroia, or through a force coming through the toes and into the ankle.
Patients who suffer from this injury will have quite a bit of pain and swelling. Usually patients are unable to put weight on the injured foot. There may be black and blue marks that develop as well. These breaks can be difficult to see with an xray. Many times, an MRI or CT scan of the foot is needed.
WHEN TO SEEK MEDICAL CARE
After an injury to the foot, if one is unable to place weight on the foot, medical attention is advised.
If the injury is truly non-displaced (the pieces of the broken bone have not shifted), then a short leg non-weightbearing cast for six weeks is recommended. Many times a CT scan or MRI is needed to show that the bone has healed.
If there is any shift of the pieces, a surgery is needed to put the pieces back in place. The pieces are held in the correct position with screws.
The danger of this injury is possibility of the break taking a long time to heal or not healing at all. This is a concern because the navicular bone has a poor blood supply.
The long-term concern with this injury is the development of arthritis in the joints of the navicular.
RETURN TO ACTIVITIES
Most individuals with this injury can be out of competitive play for approximately 2 to 3 months. If the bone takes longer to heal than usual or does not heal at all, this time frame can be delayed.
The Red Sox will need to start developing a back-up plan for Pedroia. If further studies on Monday show that he truly has a non-displaced fracture of the navicular, he probably won’t be available to play until September, at the earliest!
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