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Monday, May 19, 2014
Injury update: Jose Abreu

By Stephania Bell

The Chicago White Sox placed Jose Abreu on the disabled list Sunday due to posterior tibial tendinitis in his left ankle. On Saturday, Abreu was limping noticeably during an early at-bat and was replaced in the seventh inning by Paul Konerko.

Abreu leads the league in home runs (15) and is second in RBIs with 42 (one behind Miami Marlins slugger Giancarlo Stanton), making his loss -- even if for a short while -- that much more dramatic. But will it be a short absence? The team has not issued any type of return timetable, and realistically, it may be impossible to project at this point.

The hope would be that shutting Abreu down from all aggravating activities would help quiet the inflammation associated with his ailment and allow him to focus entirely on rehab. But once these conditions get to the point of daily discomfort, they can be more difficult to resolve. Abreu has been trying to play through the pain while simultaneously undergoing treatment, but his early exit Saturday proved that this was not enough. Between the loading demands on the foot and ankle when running the bases and the torsion through the front foot on one of Abreu’s big swings, there is no escaping the pain once the condition is flared up to this degree.

The tibialis posterior is a muscle that lies deep in the calf area, whose long tendon runs along the inner aspect of the lower leg, wraps behind the inner ankle bone and attaches to bones in the foot. When the muscle contracts, it helps point the foot and allows the ankle to move inward as well as downward. Perhaps one of its more important functions is supporting the integrity of the arch of the foot during walking and running.

Like many tendinous conditions, the most common culprit when posterior tibial tendinitis develops is overuse combined with an individual’s particular biomechanics. The pain may not be severe initially, but it can worsen over time to the point where activity, like running, becomes progressively more difficult. Abreu missed a few days in spring training because of the left ankle, so the problem is not entirely new. Chronic irritation can lead to early degenerative changes in the tendon; this is ultimately a more challenging condition to treat.

In the more aggravated stages, the athlete may be immobilized in the short term (for instance, in a walking boot, which Abreu is reportedly sporting already) to minimize load on the tendon. Other treatments designed to decrease inflammation while ensuring normal mobility at the ankle joint as well as within the soft tissue are part of the early phases of rehab. Progressive strengthening, particularly in the form of eccentric exercise, is incorporated as the symptoms permit. Arch support -- in the form of taping or inserts -- may also be a part of returning to play. Surgery is rarely required, usually only in cases where more severe tendon damage has occurred.

For Abreu and the White Sox, the hope undoubtedly is that his symptoms will turn a corner once he is afforded some extended downtime. Considering he has been in the lineup daily since April 17, the opportunity to truly rest his leg is a treatment option that hasn’t yet been tested.

The biggest task for the White Sox is trying to gauge when Abreu will be able to return with only minimal risk of a subsequent setback. There are no precise measures to guarantee such an outcome, but one thing working in Abreu’s favor is the excellent track record of the White Sox medical staff when it comes to injury management. Whether that downtime exceeds 15 days remains to be seen, but a longer absence -- even an additional week or more -- would not come as a surprise.