Tulo's Feet

Kim Klement-USA TODAY Sports

First, The Disclaimer:

As before, this stands: If an orthopaedic surgeon or anyone with greater knowledge of the subject reads this, please weigh in with corrections and embellishments. If you must sue me for infringing your copyright, well you'll get nothing because that's what I have. As ever, a simple cease and desist will be sufficient to get me to stop stepping on your feet.

Now, on to the bone spurs we have to pick...

As you all know by now, Tulo has bone spurs in both feet. Surgery is the plan to fix them. To begin, lets start by talking about what a bone spur is, where they happen, and why they occur.
They are known medically as an "osteophyte". They can occur in any large bone. In this case, they're growing out the heel bones in Tulo's feet. That's the bone known as the "calcaneus". It's the knob that makes up the bony mass of your heel. If you have a look at this xray, you can see a calcaneus with a HONKIN' big bone spur.


How, you may ask, did that come to grow there? It’s by no means the normal shape of your heel bone. Whelp, the answer is simple: irritation. You see, the plantar fascia makes up the springy connective tissue of the sole of your foot. It runs from the calcaneus to the base of the toes.


Continual pounding on the heel, over-stretching and flexing of the plantar fascia, or just plain over use of the feet from standing (all the things baseball players do) can cause plantar fasciitis (inflammation of the plantar fascia) and a subsequent spur to develop into the plantar fascia. Not all plantar fasciitis has a bone spur, but ALL heel bone spurs have attendant plantar fasciitis.

That spur is the result of irritation and the body’s attempt heal/stop the irritation/damage to the area. The outgrowth of bone is in response to a healing process. It’s almost like your body saying "If you don’t stop pounding the crap out of your feet I will MAKE you stop it by growing a big honkin’ hunk of sharp bone that sticks you in your poor tender plantar fascia". Now, what does one do about it?

Its actually theoretically a simple fix: stay off your feet and lots of time. Gentle exercise by rolling a golf ball or wooden dowel with the sole of your foot. Physiotherapy. The plantar fascia can be injected with cortisone to reduce the inflammation which would cause the body to absorb the spur. There’s even a minor surgical procedure where a small cut is made into the plantar fascia near the spur, and the body as it heals the cut dissolves the spur. Heel orthotics are a very common way of padding the calcaneus and reducing the impact allowing the spur to be reabsorbed. Other shoe inserts can be used to reduce stretching and further irritation to the plantar fascia itself.

Most physicians do not recommend surgery. And, when they do, it’s often after they’ve tried everything else, commonly over at least a year or more. As such, operating to remove the spurs is a last, drastic step (no pun intended). Often done with two slits made near the heel, a camera and instrument/s go into the sole of the foot. A procedure called an "Endoscopic Plantar Fascial Release" is performed, and the ligament is freed from the areas where the bone spur occurred or released entirely from the calcaneus, depending on what the surgeon sees. It is very likely that Tulo will have his spurs crushed and the pieces removed.

This is often an outpatient procedure done under local anesthetic. It’s a relatively simple surgery, with the patient up and walking on the surgical limb right after surgery, often in a stabilizing boot.

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The recovery time is about 6 to 8 weeks before "normal activity" is allowed. The reason this procedure is not the first thing done is because recurrences of spurs is common, as there is considerable irritation to the fascia and it is unlikely that the patient will stop using his feet. One of the biggest contributors to his bone spurs would have been artificial turf and the pounding his feet got playing on it. He'll go back to playing on the same surface that caused the issue in the first place. Hence, he has a very high likelihood of the spurs coming back.

Also, the risk of osteoarthritis of the feet is going to be nearly 100% after. By opting for surgical removal, Tulo is almost certainly facing the painful experience of arthritic feet before he’s fifty. He’d have been made aware of that fact by his physician. Opting to go ahead with surgery is not a great idea for his long term health and I certainly hope his physicians made him aware of this.

Ultimately, this means we'll see him resuming baseball activities by around the middle to the end of May and back on the field with the team in about June.

Editor's Note: This is a FanPost written by a reader and member of Bluebird Banter. It was not commissioned by the editors and is not necessarily reflective of the opinions of Bluebird Banter or SB Nation.

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