News leaked out on Thursday morning that Joel Embiid has a new injury leading up to the NBA Draft:
Embiid's agent released on Thursday afternoon that the stress fracture was to Embiid's navicular bone, one of the small bones of the mid-foot, as first noted by Wojnarowski. The surgery will be done on Friday and normally consists of inserting pins in order to strengthen and stabilize the bone. Recovery is normally quoted as four to six months, but Embiid is anything but typical.
Embiid, the seven-foot center from Cameroon by way of Kansas, is just the latest big man to have foot problems. Going back to Bill Walton, the weight and unique forces that their freakish size puts on the feet often cause significant problems. More recently, Yao Ming had to retire early due to foot problems.
Other big men, like Rasheed Wallace and Pau Gasol, have had assorted issues with their feet as well. Sam Bowie—in the man taken a spot before Michael Jordan in the 1984 NBA Draft—immediately comes to mind. It is important to note that Bowie didn't have foot problems; his were in the lower leg, not the foot.
While those three comparables did not have the exact same injuries or mechanism that led to the injuries, there are enough similarities to draw some very negative conclusions. Embiid once again dealing with a fracture, even a stress fracture, is very worrisome.
I asked Dr. Ken Jung, one of the top foot and ankle surgeons in the world, whether the size alone was the cause of the problem.
"Stress fractures can occur due to overload of the biomechanics. His foot bone structure may make him more susceptible." Jung said. "For instance, high-arch individuals are at increased risk of fifth metatarsal fractures. His overall bone alignment also plays a factor. Overall body weight, due to carrying a seven-foot frame, also plays a role."
No matter the location or causation of the fracture, Embiid is going to have to be taken off the foot for a significant period of time so he can heal. While crutches are still used regularly, he could use a walking boot (sometimes called a cam walker) to reduce the stress on his foot as well. This will impact his conditioning, but also cause problems for the bone. Bones are designed to be under some stress.
Wojnarowski also tweeted earlier that Embiid is consulting with his surgeon, Dr. Richard Ferkel, which makes it likely that Ferkel will do the surgery. The fracture is probably more significant and needs extra support. This is not an uncommon procedure.
The most comparable player that has had this in the NBA is Brook Lopez, as has Zydrunas Ilgauskas (giving Cleveland even more insight into the process.) NFL stars Julio Jones and Ahmad Bradshaw have had support screws inserted into their feet to add strength and stability.
Interestingly, there is another player in this draft with a related issue. Julius Randle had a fracture while in high school and had a screw inserted. During his pre-draft work, the question has been raised about whether the screw will eventually need to be removed. It does not appear to be significantly affecting his draft stock.
This is the second significant injury of the year for Embiid. Embiid's back issue was already raising red flags for several teams in the NBA, with reports that Cleveland was off of Embiid due to the injuries and poor workouts widespread. The injury, known as spondylolysis, is not unheard of in the pros. Andre Drummond of the Detroit Pistons missed only a few weeks in 2013 after having suffered the injury and showed no problems.
More worrisome is that Embiid suffered a second stress fracture in less than a year. Given how little he has played, there has to be a worry that his body can't handle the stresses of the game. Another, even more concerning possibility is that Embiid has some systemic issue that makes his bones brittle.
Dr. Jung told me this is going to be a big concern. "Having multiple stress fractures can certainly indicate a systemic problem. Stress fractures can occur due to metabolic reasons where the body's ability to heal from the stress of working out is overloaded. Factors affecting bone health include endocrine/hormones, diet, and genetics. Training regimen plays a huge factor, especially if the individual is undergoing intense workouts or a new workout regimen."
This latest medical question adds to Embiid's file. While it's too early to say how risky this specific injury makes him in both the short and long term, the specter of Sam Bowie is starting to rise. As with Nerlens Noel last season, Embiid won't drop far if he does, but Noel's situation (an ACL reconstruction) was far more predictable than the multiple injuries for Embiid.
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