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Thursday, May 22, 2014

Jose Abreu’s ankle injury will test the depth of the Chicago White Sox

By on 5/22/2014 10:00:00 AM

The Chicago White Sox took a big risk when they agreed to terms on a six-year, $68 million deal with Cuban slugger Jose Abreu. Almost two months into 2014, that contract looks like a bargain.

Unfortunately for manager Robin Ventura, an ankle injury has forced his biggest power threat to the disabled list, testing his roster’s depth in a competitive American League Central division. 

Not much was known about Abreu before signing with Chicago. However, the one aspect of his game with the biggest upside was his power.

Abreu has followed through in that department in his first 173 big league at-bats. The right-handed hitter owns a .260/.312/.595 line with 15 home runs and 42 RBI. Prior to hitting the DL, he was the AL leader in home runs, RBI, slugging percentage and total bases.

The first baseman dealt with ankle soreness for about a week before the organization felt it was necessary to sit him on the sideline. Scott Merkin of explained Abreu’s ailment on Twitter:
What exactly is posterior tibia tendonitis? Dr. Adam Bitterman explains the injury itself, initial symptoms and usual treatments in detail:

The posterior tibialis tendon, a.k.a., the posterior tib, is a muscle that travels from the back of the calf and crosses the ankle joint along the inside of the ankle, directly behind the medial ankle boney prominence, (medial malleolus).

Its attachment points include various landmarks within the foot, mostly along the medial and plantar surface including the navicular, cuneiforms, calcaneus and metatarsals. Because of its location, and relation to the axes of motion involving the boney articulations of the foot, its main responsibilities include rolling the foot inward and pointing the toes downward, (medical terms: supinating the foot, inverting the hindfoot, secondary plantarflexion). The PTT also serves as a dynamic stabilizer to the medial longitudinal arch of the foot.

The anatomic pathway of the tendon, and its sharp turn at the ankle joint, may be one reason for it becoming inflamed. In high performance athletes, repetitive motion may lead to micro-trauma which can trigger an inflammatory cascade. In older individuals, there is question about whether inflammation of the tendon may result from a tenuous blood supply or watershed area, an area where tendon nutrition is lacking.

Initial symptoms may include pain as the tendon travels behind the medial malleolus. If this condition progresses and is not treated appropriately, the tendon is at risk for rupture which may result in progressive boney deformity.

As with any inflammatory pathology involving a muscle or tendon, the key is to rest and remove any insult that may have been causing pain. It is key to eliminate any stress from the inflamed tendon. Rest, ice and anti-inflammatory medicines as well as shoe inserts may help alleviate the symptoms. The use of a walking boot may also help with the symptoms. 

Ideally, treatment allows the inflammation to resolve thereby preventing a rupture and a need for surgery.

Based on what Adam details here, it's not surprising to see Abreu land on the DL. The last thing Chicago needs is for him to have surgery and be out for an extended period of time.

The 27-year-old was clearly the biggest power threat in Chicago’s lineup. He’s the only player with a double-digit home run total. Adam Dunn is second on the club with seven bombs. Alexei Ramirez’s 32 RBI is closest to Abreu’s total, but is still 10 behind.

Paul Konerko will be getting most of the playing time at first, but Dunn will get penciled in on occasion. Having their veteran presence is a plus, but the production won’t be anywhere near what Ventura is used to seeing at first base.

Dunn is in the final season of a four-year, $56 million deal. He’s appeared in 38 games in 2014, hitting .248/.403/.472 with those seven home runs and 18 RBI in 125 at-bats.

Konerko heavily considered retirement following 2013, but signed a one-year, $2.5 million contract with Chicago to return for his 18th season. He’s put together a .190/.232/.333 line with two home runs and 11 RBI in 63 at-bats.

An increase in playing time could bring more production out of Konerko, but Ventura’s lineup has become a lot tamer without Abreu.

The White Sox currently own a 23-25 record and are seven games out of first place in the AL Central. And that was with Abreu appearing in 44 of those games.

This division is deep with talent. The Cleveland Indians have underperformed, but are fresh off a 92-win season. The Minnesota Twins and Kansas City Royals are both hovering around .500.

Unfortunately for everyone, the Detroit Tigers are one of the hottest teams in baseball. They’ve lost three games in a row, but put together six straight wins last week. Their 27-15 record is second-best in the AL, producing a five-game lead in the Central.

This hot streak coincides with Miguel Cabrera waking up at the plate. After hitting two home runs and collecting 15 RBI through 22 games played in April, the third baseman has slugged five round-trippers and driven in 25 so far in May (19 games).

With Abreu out and Detroit playing well, there is a chance Chicago will continue getting buried toward the bottom of the division, which they can’t afford.

The White Sox will have to lean on solid pitching and timely hitting to stay afloat until their slugger returns.

That will be tough. Their 4.78 team ERA and 1.49 team WHIP are both the worst in baseball. The rotation will get a boost Thursday when Chris Sale gets activated after being sidelined with a flexor strain.

Ventura and the White Sox are facing a crucial time in their season, and someone needs to pick up the slack while Abreu is on the sideline if they plan on competing in 2014.

Dr. Adam Bitterman also contributed to this article. He is an Orthopedic surgery resident in Long Island. Dr. Bitterman did not directly participate in the care of the above mentioned individual. His views do not reflect that of his employer. You can follow Adam on Twitter @BittermanJAMB.

You can follow Matt on Twitter: @mmusico8.

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