Giving heel pain boot a key to recovery
With Ortiz injury, Dr. Giurini gives insight to handling bursitis
Given that the Red Sox and Yankees have spent a good deal of this season nipping at one another's heels in the standings, the news this week that David Ortiz will spend some time strapped in a walking boot is a bit worrisome. After Ortiz disclosed to the team medical staff that he was experiencing pain in his right heel, an MRI revealed the cause -- bursitis.
Removing Ortiz's bat from the lineup won't have a positive effect on the divisional race, but there is no doubt that it's the right call for the long run.
"Rest is absolutely the priority in situations like this," said Dr. John Giurini, chief of podiatric surgery at Beth Israel Medical Center. "The sooner, the better, in fact. With soft tissue injuries, you need to restrict any activity that might cause further irritation. That's what bursitis is, an irritation and inflammation of one of the bursal sacs."
Bursal sacs are small pouches of fluid that can be found throughout the body. They are usually found around joints in the area where tendons attach to the bone. They often lie between the tendon and the bone, and they reduce the friction and allow us more freedom of movement -- when things are working properly that is.
"There are two bursal sacs in the area of the heel -- where the Achilles tendon attaches to your heel bone," said Dr. Giurini. "One is between the tendon and the bone, and the other is on the outside of the tendon, just beneath the skin. There are any number of ways they could become irritated; overuse, repetitive movement, a baserunner might lunge for the base, and that sudden pull might irritate the tendon and the bursa."
And then a minor aggravation will become a major pain -- step by literal step. That's why Ortiz is wearing the restrictive boot for a while. The Sox have not put him on the 15-day disabled list, which would indicate that they are expecting him back fairly soon. Ortiz said he thought he'd miss only a week. The other bit of good news he shared was that his Achilles tendon was fine.
"That is good news," Dr. Giurini said. "Very often you will find that there is some tendinitis as well as the bursitis. Along with the boot, I would imagine that he'd be icing the area to reduce any swelling. Anti-inflammatories might be appropriate. Of course he'll have access to therapies like ultrasound, electro-stimulation and active and passive stretching.
"He might wear a simple heel lift after he returns. That would reduce some of the pressure on his Achilles. If the doctors or trainers feel there's a need, they might prescribe an orthotic device."
Major League medical staffs work full time to get their injured players back to work. Most of us can't count on that kind of attention, but we can work on prevention.
"Stretching is important before you begin any exercise routine," Dr. Giurini said. "Loosening up your Achilles will help you prevent some heel and foot problems, but you also want to stretch your hamstrings, your back and your upper body, too. And you always want to have good supported shoes that are appropriate for the activity."
In other words, if you're playing softball at the company picnic, don't try to beat out a bunt while wearing flip flops. Of course, if you were David Ortiz, you wouldn't try bunting in the first place. A home run trot is much easier on the feet.
Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.