Pressed in between thrilling March Madness games was the news the Oklahoma City Thunder star Kevin Durant would be shut down for the remainder of the year due to a setback with his injured right foot.
Durant, who led the NBA in scoring each of the past five seasons, is expected to undergo a bone graft on his injured right foot, which will knock his rehab schedule back four to six months.
Here’s a statement about Durant’s injury from Thunder general manager Sam Presti:
“As we communicated last week, Kevin was going to use this time to engage in consultation and evaluation regarding the persistent soreness in his right foot at this stage of his rehabilitation. As part of this process, Kevin and Thunder personnel traveled to two additional specialists this past week; Dr. Martin O’Malley in New York City and Dr. James Nunley at Duke University. These in-person consults were designed to further supplement the previous evaluations of Dr. Bob Anderson. Several conference calls and discussions amongst the specialist team concluded that, while the majority of the soreness in Kevin’s foot was related to continued inflammation of the cuboid bone and would subside with rest, the evaluation process also determined that the Jones fracture of the fifth metatarsal, which had shown significant healing previously, was now demonstrating signs of regression.”
Presti continued, saying that Durant’s long-term health will be better protected through the bone graft operation.
“The bone graft is the standard procedure for the five to eight percent of Jones fracture surgeries that do not initially have success or experience setbacks sometime within the recovery period. While everyone is disappointed that Kevin falls into that group, we are encouraged that the bone graft procedure has historically demonstrated long-term health and stability. Dr. O’Malley will perform the bone graft surgery early next week in New York. He has extensive bone grafting experience amongst athletes and has been consulting on the case throughout. Kevin will miss the remainder of the 2014-15 season and is expected to return to basketball activities in the next four to six months.”
Dr. Silverman Breaks It All Down
First off, let me start by saying that I feel Dr. Anderson’s pain. Jones fractures are hard to manage. They heal very slowly without surgery and require 6-10 weeks of casting and nonweight bearing. More than 40 percent won’t heal without surgery.
Surgery is the more conservative approach, with a full recovery rate hovering around 95 percent. The surgical incision is 1 cm long. The procedure takes 20 minutes when you get it perfected. That said, it’s hard to do and there are tons of pitfalls that I have learned to avoid from both Dr. Anderson and Dr. Nunley. Patients are able to walk right away. They are happy, heal quickly and are back to all activity by 7-8 weeks…most of the time. Then there are cases like Durant.
There are five potential reasons why Durant’s foot didn’t heal:
1. The surgery wasn’t good enough. I seriously doubt this was the case, given that his surgeon is one of the guys who actually came up with one of the best implants on the market. Being off by a few degrees, using too long of a screw or too small of a screw can do it though.
2. The patient’s nutritional status is bad. Durant needs his vitamin D levels checked.
3. He has undiagnosed biomechanical problems. He could have ankle instability. If he lands on the outside of his foot he will stress the healing bone. Calcaneocuboid instability, high arch (pes cavus), abnormal heel shape (heel varus) or even in-toeing (metatarsus adductus) can cause the Jones fracture surgery to fail.
4. Infection. An unusual cause of non-union of this bone would be an infection, but it should always be kept in the back of the mind. At the same time of the grafting, doctors will often biopsy the non-union site to confirm no infection is present.
5. No good reason. This is the most frustrating. Sometimes the best surgeon can preform a perfect surgery on a healthy patient, and do to a fluke or seemingly random reason, a setback can occur.
It seems likely that a biomechanical issue is to blame, but we may never know for sure. Hopefully his upcoming surgery goes well and he’ll return to MVP form next season.
