To understand why Jose Abreu's ankle injury is so serious for the White Sox, you need context.
Having someone explain posterior tibial tendinitis is nice, but if you don't learn that Abreu has had problems with this condition going back to his days in Cuba, and if you don't know just how good the White Sox medical staff is, you have noise, not signal. Abreu is headed to the disabled list, but understanding why is much more important to analyzing the future of Abreu, the White Sox and Abreu's fantasy prospects.
Posterior tibial tendinitis is a very common injury in high-impact sports. For baseball, it is less common due to the reduced physical load factors, but it is not unheard of. The swelling in the tendon between the calf and the foot can create localized tenderness and create movement patterns that can threaten the calf muscle, the Achilles tendon and generalized foot function.
Dr. Adam Bitterman explained to me about the treatment for this type of ankle condition:
"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."
While the injury can seem to pass, it tends to be one that lingers with a period where the management of the injury does not reduce function. The major concern is that the chronic injury damages the tendon to the point of tendinosis.
Surgery is not normally needed in these cases, but it can be done in extreme cases. There is no indication that this is being considered for Abreu, though it is always in play if there is not a change with standard treatment. Look for Abreu to be back out jogging or hitting about a week to 10 days after hitting the DL for an indication if this is going beyond the minimum.
Abreu has dealt with inflammation in his ankle for the better part of a month, according to Doug Padilla of ESPNChicago.com, but it has been getting progressively worse. It got to the point where Scott Merkin of MLB.com said Abreu was "playing on one leg." The shift to designated hitter was intended to help, but it's clear even that wasn't enough.
Abreu also dealt with a left ankle injury in spring training, and while Abreu has said the pain was in a different part of the ankle (front versus back), the focus on the ankle indicates a movement-pattern issue. Sources tell me that there were some concerns about Abreu's lack of a medical file when he was a free agent with scattered reports of some lingering issues, including the ankle.
One major factor that Abreu has going for him is the White Sox medical staff. Herm Schneider has some of the best results in the major leagues over the last decade. As I detailed in this article a few years ago, Schneider and his staff essentially saved one year's salary out of 10, like a Subway punch card! If Schneider and his staff could keep Jermaine Dye healthy with his shattered leg, a bit of ankle tendinitis should be no big deal.
A key note is that while Abreu has been dealing with this, the problem has been with running and fielding (or at least standing in the field). Abreu's power in raw or advanced terms shows no big drop-off, which suggests he's not losing his base or that his power is not generated from his legs as much as some hitters, such as Joey Votto.
With both Adam Dunn and Paul Konerko available, Abreu's absence can be filled quickly and easily. Konerko is on a "victory tour" of sorts. Once Abreu returns, the question is how much he'll have to DH. That limits the team more than it takes away from Abreu's value, but Dunn is already trade bait.
The White Sox will be fine without Abreu, largely because this team isn't a contender. They do swap Abreu for upside outfielder Adam Eaton, who is healthy now, at least for a while, and get the chance to fill in with Konerko. There may be some effect on Abreu's run for Rookie of the Year, though a short absence shouldn't cost him much.
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