Bigfoot

The newest addition to the Cubs pitching staff, 37 year old (38 on April 2nd) Jon Lieber is apparently ready to pitch. His tenure in Philadelphia ended abruptly last season in the 6th inning, on June 20th, while backing up home plate on a play in Cleveland. It was one rotten day for him already as he had given up 7 runs on 10 hits and was on the hook for his 6th loss. Initially, and at least for the first few days, it didn’t look like anything serious, probably just the run of the mill lateral ankle sprain.

This was the initial report from the Phillies mlb.com site:

June 21st: Ken Mandel, of Philadelphia.Phillies.MLB.com, reports Phillies SP Jon Lieber (ankle) injured his right ankle Wednesday, June 20, while backing up home plate. Lieber had the ankle checked out and it turned out to be largely a muscular injury. Because of off-days, the Phillies should be able to give him extra time to heal and he won't be needed until Friday, June 29, at the earliest.

Mirroring this information, Will Carroll, from Baseball Prospectus, in his Under the Knife column on 6/22/07 said:

The Phillies are also waiting to see how Jon Lieber responds after spraining his ankle in Wednesday's start. He limped off the field after rolling the ankle running to back up home plate after a hit. It didn't look serious, but we should know more by the time his bullpen session comes up this weekend.

Day three injury update:

June 23: Ken Mandel, of Philadelphia.Phillies.MLB.com, reports Phillies SP Jon Lieber (ankle) had his ankle wrapped Friday, June 22, however, he is still expected to make his next start Wednesday, June 27.

Now we know that this was no conventional ankle sprain.

Lieber apparently was having some problems with his foot starting the first week in March in spring training (per a C. Muskat interview this year). Older pitchers expect to have a lot of aches and pains. Apparently it wasn’t enough of a nuisance to get an MRI at the time. Still, it certainly could have been that Lieber's foot was giving him some soreness at the start of the season with the tendon having degeneration, inflammation or wear problems and it finally ruptured with the June 20th injury.

Looking at Lieber’s last 5 starts with the Phillies, four were awful, including three-10 hit outings each over 5 innings and one 13 hit outing over 6.2 innings. Nobody was blaming those outings on a inflamed foot tendon and it must not have been overly obvious as in the midst of that ugly string on June 9th, he did throw a beautiful complete game 3 hit shutout against the Royals.

With an acute injury in Cleveland and significant swelling, MRI imaging of the foot/ankle was obtained and it showed that the injury was something fairly uncommon. He had a rupture of the peroneus longus tendon, well below the outside of the ankle as the tendon goes toward the bottom of the foot.

Then, after the Phillies team orthopedist evaluation, came second opinions by sub-specialty trained foot and ankle orthopedic surgeons.

Finally, USA Today reported:

AP--Jon Lieber will undergo season-ending surgery on Friday (July 6th) to repair a ruptured tendon in his foot.

Lieber was 3-6 with a 4.73 ERA in 12 starts this season. He was the Phillies' opening-day starter in 2005 and '06, but will become a free agent after this season. "He pitched some good baseball for us," said Phillies manager Charlie Manuel. "If things had been a little bit different, he could've pitched better. He had the talent." Lieber will have the surgery at the Mercy Medical Center in Baltimore, the team said.

Jon Lieber had his peroneal tendon repair surgery on July 6th at Mercy Medical Center in Baltimore, The head of this center's foot and ankle department is Dr. Mark Myerson, who is one of the most renown foot and ankle surgeons and who apparently trained the Phillies local foot and ankle specialist (Dr. Steven Raiken). We are talking high end orthopedic sub-specialists here (their practices focus only on foot & ankle care). I'm not sure which surgeon did the tendon repair but it appears he was in very good hands.

More newswire stuff:

Philadelphia Phillies SP Jon Lieber (foot) had successful surgery, Friday, July 6, to reattach a tendon in his right foot, according to the Associated Press. He'll be in a walking boot for three to four weeks.

Sat, 14 Jul: Phillies | Lieber moved to 60-day disabled list

Tue, 7 Aug 2007: Phillies | Lieber cleared to begin rehab program

Finally, from C. Muskat, at the cubs.com site:

Lieber…finished his rehab in early October. Now, he said, everything is fine, and Lieber is back on his normal off season routine.

From my perspective as an orthopedic surgeon, this was an injury I had to do some literature review to learn more, as I haven’t seen an isolated peroneal longus rupture. I've read the chapter in Dr. Myerson's textbook. I’ve seen and treated many peroneal tendon subluxations (partial dislocations) where the two peroneal tendons (longus and brevis) slip around the injured or stretched retinaculum that supports these tendons just behind the ankle. That situation was the infamous “bloody sock” injury that Curt Schilling had back during the 2004 World Series. Schilling’s memorable treatment was very unconventional as the former Red Sox team physician, Dr. William Morgan, put stitches through the skin deep enough to stabilize the slipping tendons as a temporary measure to get him through the playoffs. In the offseason, he had more definitive reconstruction of the injury.

Here is a link to the anatomy of the outside of the ankle/foot.

The peroneus brevis tendon attaches to the base of the 5th metatarsal and is responsible for eversion (outward rotation) of the foot. The longus tendon goes under the foot and ultimately attaches to the undersurface of the 1st metatarsal. This stabilizes the 1st metatarsal and foot from rolling over in both push off and landing, so it’s function is very important in pitching from a mound.

Lieber’s injury was a bit lower down (distal) into the outside portion of the hind foot, well below the ankle. I could see why there might be a delay in diagnosis and confusion with a conventional ankle sprain which is a lateral ligament injury (ligaments between the fibula and talus/calcaneus and tibia). Lateral ankle sprains will look similar to this injury with lateral ankle and foot swelling and an X-Ray that doesn't show a fracture. For most ankle injuries, it’s conventional to get X-Rays to make sure there is no fracture. MRI’s are usually not ordered unless the ankle sprain is taking too long to heal. Most severe lateral ankle sprains take 2-6 weeks to heal. In Lieber’s case, the correct diagnosis was made very quickly. So getting the MRI early on meant Lieber’s swelling and tenderness initially didn’t match up to where a typical ankle sprain should have been tender. Score one for the Phillies athletic trainer and Orthopod showing excellent clinical decision making, a very fine job indeed!

In the case of a peroneal longus tendon rupture, there is a tunnel/groove in the outer hind foot, which involves the cuboid bone where the peroneal longus tendon passes and often there is a spur or small (sesmoid) bone that can lead to friction and subsequent tendon rupture. One of the larger published series I found on this had only 41 patients of which only 11 patients had isolated peroneal longus rupture as Lieber had. So it’s a pretty rare (or at least not commonly diagnosed) injury. In the days before MRI scans (the early 1980’s) this injury had virtually not been reported on in the ortho literature. Also, I couldn’t find any previously treated professional pitchers with this injury, but the orthopedic literature suggests athletic patients do well when the tendon rupture is surgically repaired.

Thus, if you see Derrick Lee backing up the catcher on throws from the outfield when Jon Lieber is pitching, you’ll be a bit more understanding. That is, unless Jon Lieber has already let in 7 runs by the 6th inning.

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  • good...he's been stinking up the durham bulls for a couple years now.

  • Rays DFA Hak-Ju Lee.

    Olt for Lee and the circle of life is complete

  • obviously....

    dusty would have to start baez because both lastella + castro would be pitching because all the other pitcher's arms would have fallen off months ago. it would piss dusty off because baez is a rookie and theo couldn't go out and get him a 39 year old DH to play 2nd. i imagine it would be a 2-box-of-toothpicks night.

    lou would have quit his job already, so that's irrelevant and a trick question.

  • just a theoretical thought...if Dusty was manager (WWDD) or if Lou (WWLD) was manager...

    would Javy Baez be in tonight's lineup?

    my thought is:

    Dusty... Bonifacio would have been brought up and started at 2B
    Lou..."I like playing the kids, really I do, but but but Jonathan Herrera really needs to play to stay sharp."

  • He was replying to tweet who said error should have been hit

  • Added a 'recent comments' block to the bottom of every 'story' page. Thought it might be helpful. Comments welcome

  • Jeff Russell and Rafael Soriano DFA's to make room for the callups (Berry and Cahill)

  • The next 4 weeks should answer this for us. If Castro starts hitting again and neither Baez or La Stella perform, he'd be on a playoff roster. If not, and one of those other two guys does well, I wouldn't be surprised if he was left off. A key error or mental lapse in a one game playoff would be killer and he is too prone to them.

  • To put a finer point on it, Baez playing second and hitting 7th tonight.

  • "This is the show. We have certain expectations here. That's why you don't play." from a Tweet from Arrieta. I who do you think he is talking about.

  • "This is the show. We have certain expectations here. That's why you don't play." --Jake Arrieta on Twitter.

    Whoa!

  • I'll check back in on a day that Starlin doesn't make three errors. But for now I would say him not making the playoff roster is a stretch. Who do you trust more than Starlin to be a RH backup middle infielder? Herrera has no bat at all, and Baez has been in AAA all season and may be as error prone as Castro and may strike out a giant proportion of the time he's at the plate. I'm also less than convinced that La Stella will step in and be a significant contributor. Starlin is at least a big part of the 2B picture for the remainder of the year.

  • Sadly, nothing is sticking to the wall. The only thing still lingering is the smell from their pitching outings.

  • i think they were just throwing shit at the wall to see what sticks.

    they wanted to push for the post-season without giving up anything. thank gawd for the cubs winning tear and SF's failure tear...hopefully that holds up until the season ends.

    once we're into the post-season (if that happens) then it doesn't matter about the 4-5 slot pitchers. arguably, the pen is much more important at that point when it comes to anyone but the top-3 starters.

  • Signing Haren was very curious, at best. An over-the-hill fly ball pitcher can survive at Wrigley in April, May & June, when it's cold and the wind tends to blow in (i.e. the ballpark plays "big"). But, signing him to pitch at Wrigley in July, August & Sept., when it's warm and the wind tends to blow out...well, Theo, what did you expect? Gotta believe the Reds will be running up to the plate to get their swings against Haren tonight.

    Come on, offense -- we're gonna need another 6-7 runs tonight!

  • ...or they could wait until tomorrow and haren can be DFA'd...maybe...probably not...sigh.

    gotta imagine j.russell is on his way out at the very least.