With Joel Embiid’s foot injury adding so much confusion to the NBA draft, I asked Dr. Ben Wedro of MD direct to help provide a little clarity – at least about the top-rated center. If you’re looking for help on the Andrew Wiggins/Jabari Parker debate, this isn’t the place (though I’ll have more on that tomorrow).
Q: What might have caused Embiid’s foot injury?
The navicular is located in the mid foot and is responsible for helping maintain the arch of the foot from heel to toe and transverse stability of the foot. It and the ligaments that attach to the mid foot to flex at the beginning of a stride and lock as the foot pushes off.
They are responsible for taking the load of the weight of the body as it comes down an distributing it. So, when you’re 7-foot-whatever and 300 pounds [ed: Emiid’s listed weight was 250 pounds at Kansas], that takes more load than if you’re me and and 5-9, 160. It’s one of those things that happens unfortunately. I don’t know if we’re built to be 7 feet.
Causes include increasing activity too quickly, poor equipment (in this case, perhaps poorly fit or supportive shoes) and bone insufficiency. Normal with the latter, it is due to osteoporosis but in a large 7 footer, it may be that the bones in his foot may not be able to support the size of his body.
When it is injured, it often takes time to make the diagnosis of the navicular stress fracture because it is not easily seen on x-ray.
Q: Considering his back injury also, is it possible Embiid’s bones are weak?
Unlikely. He’s a healthy guy. The think you think about with people with back fractures and bone problems is osteoporosis, and that’s more a disease of aging. You see that in older people, especially women who haven’t deposited calcium in their bones earlier on in life. They have a calcium deficit. So, that’s unlikely the case.
His bones are probably fine. His height is a problem.
Not a problem. You can’t teach height. But it puts more stress on the anatomy of the bones in the body to distribute all that pressure that comes through jumping and running.
As to the relationship with his previous back injury, the only relationship I can think of is being deconditioned and increasing practice and play time too quickly.
Q: What do you make of two screws being inserted into his foot?
The fracture needs to be stabilized and the screws are used for internal fixation. This is the expected procedure.
With either operative or non-operative approach, up to 90% of athletes can return to their level of competition.
Q: Do you think that percentage is lower for elite athletes, because they must climb back further to a higher level?
They have more incentive to do that or facility to be able to do that. They have more people around them to get them there.
He goes eight hours a day, six days a week. That’s their full-time job, and he has a team of people – from a chiropractor to massage therapist to a physical therapist and a doctor – working on your foot six hours a day.
Q: How can he and his team minimize of suffering another injury?
Part of his rehabilitation and evaluations of his injuries in his rehab will be looking at his footwear and seeing how they can help him with that – whether that’s orthotics or a specially built shoe for him – would probably be appropriate.
You have to work hard on his mechanics. The people will be looking hard at how he lands, how he takes off, how he runs and try to minimize the amount of stress on his feet by doing that.
They’re not going to tell him not to run fast. They’re not going to tell him not to jump high. They’re going to try to work with his natural athletic ability and maximize it.
So, if Embiid returns to full health, preemptively limiting his minutes to avoid future injury would be no more effective than employing that strategy with any other player?
That’s right.
As long as they’re comfortable that his mechanics are together. Let’s say they find – and I don’t know this – but let’s presume he has mechanical issues with his gait or his jumping or whatever. if they don’t correct, then that’s a different story – or if he cannot correct that.
If they find that he is mechanically sound and he’s fully recovered and he has no pain, then he should enjoy a long, healthy career.
That leaves a lot of ifs, though it is helpful to know exactly where the uncertainty remains.
Is he a normal 22-year-old? Is he the next Greg Oden? If we all knew the answer, we could predict the future.