I’m always amazed to see athletes come back to play. I know just how hard everyone works to get athletes competing again. As March Madness is in full swing, I thought I would provide some insight into Duke’s point guard Kyrie Irving coming back – Turf Toe and all. His big return to the hardwood this past Friday night, after not playing for 3 1/2 months because of a serious right big toe injury against Butler in early December, marks a huge boost for the Duke Blue Devils.
We all know how good the 6′ 2″ star is on the court and now we know how tough he is in the athletic training rehab room. Overcoming a serious case of Turf Toe is tougher than anyone can imagine. Here’s how Kyrie’s injury probably progressed for the 15+ weeks that he didn’t play for the Duke Blue Devils:
Week 1: Test, tests and more tests. The orthopedic exams by the Duke medical staff, which is one of the most respected groups of sports medicine experts in the country, would include x-rays, an MRI and a CAT Scan because of the involvement of the sesamoid bones under the first metatarsophalangeal joint, commonly referred to as the “ball of the big toe”.
The decision is to manage this injury non-operatively and a conservative plan is implemented.
The player is wisely fitted with a cast, provided crutches and given the “you better not put any weight on this foot if you ever want to run again” scare speech. Rest is king because the torn ligaments that stabilize the under-surface of the big toe require a great deal of healing. Any additional disruption of those ligaments may results in prolonged laxity of the complicated great toe mechanism. The results of such a problem are not good.
Weeks 2 -4: Upper body conditioning, total body flexibility, non-weight bearing pool conditioning and all the necessary modalities to decrease localized swelling; these exercises dominate the rehab plan. The objective: Decrease swelling, minimize pain and avoid all activities that interfere with the all-important healing process of Kyrie’s Turf Toe.
Weeks 5 – 8: Shifting activities will make any athlete excited – it signals progress and cures boredom. Initially, non-weight bearing components will be added like toe range of motion and bike riding. These will help lighten the mood for any competitive athlete who is now tired of watching his teammates having fun – and winning – without him. Somewhere in middle of this phase of his rehab schedule is when they probably removed the cast and placed the player in a walking boots. As an aside, I wonder how Kyrie made it from class to class with his cast for that time period.
Weeks 9 – 12: During the many exams of Kyrie’s great toe, they discovered that he genetically had an additional sesamoid in his base of his right or injured big toe. This unusual finding is referred to as bipartite sesamoid bone. It’s unrelated to the injury and it is not present in his big toe on his left foot. Because of this finding, they most likely prolonged his controlled walking/running activities more than usual while closely monitoring any pain within the sesamoid structures located in the ball of the toe.
By the end of this phase, his precise orthotics have been adjusted 2-3 times and the plan for his playing shoes and Turf Toe tape job would have been clearly documented.
Weeks 13 – 15: This is the phase of the rehab program that probably kept a few of the Duke’s great athletic trainers awake at night thinking about the progression of Kyrie’s activities and the loads on his injured foot. There is a delicate balance to pushing a player forward without creating a situation where the injury regresses. Players want to play and we, as sports medicine specialists, know that and want them to get back playing. Players will lie and “tough it out” just to get that ball back in their hands. I’m sure this future superstar was no different.
With an organized approach that would make NASA proud, Duke’s medical staff finely tuned Irving’s ability to run, change directions and jump. These agility and basketball drills were gradually increased in both volume and intensity over a 4-6 week period of time, based on the player’s symptoms and subjective feedback.
The media hype is on. The coaches, the administrators and everyone else is asking the same question: “Is he ready to play?” It’s not an exact science to bringing a player back “on time”, but everyone wants you to convince them that it is so they can sleep better.
The process of making this decision for an Athletic Trainer plays like a highlight reel in his mind: “Kyrie’s proved it over and over again in his rehab. I’ve been there for every treatment and ever revolution on the bike and every one-on-none basketball drill on the lonely end of the court. I’ve looked him in the eye and had the conversation with him at least a dozen times.”
I can see it now, Coach K asking if he can play. The typical response for the Athletic Trainer cuts through the air with sharp confidence: “Heck yeah, Coach. He’s more than ready!”
As you can see in this video, Kyrie had a traditional Turf Toe tape job with a moleskin reinforcement anchored to solid ankle tape support. He also had two steel shank inserts placed under his shoe’s custom orthotics to provide exceptional support to the forefoot and great toe.
The combination of the ankle tape job, the Turf Toe strapping, the custom orthotic, and the double steel shank is the perfect plan to allow for normal alignment of the injured toe while minimizing the extension of the entire forefoot.
Duke 73 Michigan 71. Duke moves on to the Sweet 16. Kyrie Irving expects to play a much bigger role now that he has two tournament games under his belt.
Personally, I love to see these type of medical success stories. I’m thrilled for both Kyrie Irving and the Duke University Athletic Training Department. Few know the amount of hard work and dedication it takes on everyone’s part to see that #1 Duke jersey walk out onto that basketball court after a very serious injury.
I’m happy for this young man and I’ll be cheering for him and his Duke Blue Devils as they try to earn a ticket to Houston.
Cheering for Duke…..coming from a UConn graduate, that’s saying something.