For Derek Jeter, the past 16 months have represented the most miserable period -- perhaps the only miserable period -- of a career that has by and large seemed like the result of a Mephistophelean pact.
To review: Jeter broke his left ankle while lunging for a grounder during the 12th inning of Game 1 of the 2012 ALCS against the Detroit Tigers. A week later, he had surgery to repair the fracture, which involved the implanting of a metal plate and screws. He pronounced himself healthy last spring, but his 2013 season soon devolved into a series of dispiriting setbacks.
An MRI last April showed a new crack had formed in his ankle. He played in his first regular-season game on July 11, only to return to the disabled list after one game with a right quadriceps strain. He came back in late July, but hit the DL again after four games with a strained right calf. Finally, after a two-week stint on the field in late August and early September, renewed soreness in his ankle shut him down for good, with 17 games and a .190 batting average on his bottom line.
Last Wednesday in Tampa, Jeter officially announced what he had indicated on his Facebook page the week before: 2014 will be his final season, no matter what. The announcement incited the typical round of big picture questions. Where does he rank among the Yankees' all-time greats? Might he be the first player to be unanimously inducted into the Hall of Fame? Does he really aspire to become the next Farrar, Straus and/or Giroux?
There is a more pressing matter at hand. "I can't reiterate enough that we still have a season to play," Jeter said on Wednesday. The Yankees, as presently constituted, desperately need their shortstop to do what Mariano Rivera did last year, which is to return from a devastating injury to give them one more elite season on the field even as garlands are being draped around his neck in stadiums across baseball. Can a player who will turn 40 in June, with his particular set of recent maladies, play an effective 150 games at his sport's most athletically demanding position?
To try to answer that question, I turned to a pair of physicians at New York City's Hospital for Special Surgery, Dr. Rock Positano and Dr. Josh Dines. While it must be emphasized that neither Positano nor Dines has examined nor treated Jeter, both know baseball, and both know feet. Positano is a renowned foot specialist who in the 1990s finally cured Joe DiMaggio of the heel pain that had plagued him late in his career, and ended it prematurely. That Positano is the founder and director of HSS' Joe DiMaggio Sports Medicine Foot and Ankle Center is one indication of the Yankee Clipper's gratitude. Dines is an orthopedic surgeon and an assistant team doctor for the Mets, and recently collaborated with Positano and two other physicians on a textbook called Foot and Ankle Sports Medicine.
The doctors agree that, as far as the integrity of Jeter's ankle, past events are not indicative of future results. That Jeter suffered a new crack in the joint last spring, when he resumed baseball activities less than five months after sustaining the initial injury, does not mean that he is in any particular danger of re-fracturing it in 2014. Jeter's competitive drive could have worked against him during his first attempt at a comeback a year ago, as he seems to have attempted to do too much, too soon.
Bone that has been repaired with a metal plate is prone to "stress risers," highly localized stresses at the points of the plate's attachment. These can develop into fractures in patients who have not properly heeded Wolff's law, which describes how bone strengthens via the application of force, but that it must be applied gradually, over time. "Around October, we start seeing a ton of stress fractures in metatarsals, because people training for the New York Marathon have suddenly jumped from six-mile runs to 15-mile runs," Positano said.
Unlike what turned out to be the case last spring, the doctors said Jeter's ankle has had more than enough time to heal, and it is now likely structurally sound after an offseason in which Jeter has said he worked out more feverishly than ever before. While he may experience problems with the joint later in life, like arthritis, he probably won't feel much more than soreness between now and October.
Positano and Dines have little doubt that the cascade of injuries Jeter suffered during his multiple aborted comeback attempts last year all stemmed from his still weakened ankle, and could also have resulted from his eagerness to return to the field. "The foot and the ankle are primarily shock absorbers, and protect everything above them," Positano said. "When a person has a compromised biomechanical situation, there's a direct effect on what happens above it."
Adds Dines, "Your body wants to protect what was injured, but the stresses are simply redistributed elsewhere, which can lead to imbalances and then injuries due to compensation." Such as, say, to the opposing quadriceps and calf.
The good news for Jeter and the Yankees is that his recovery and rehabilitation time have now likely been long enough that such compensatory injuries will no longer prove an issue. The doctors expect that Jeter has undergone motion analysis -- in which a patient's gait is digitally analyzed to uncover biomechanical abnormalities that might lead to imbalances -- and might wear orthotics or even a brace to ensure that forces are being properly distributed through his lower extremities when he moves. "These teams have become so astute, and the Yankees have an excellent medical staff," Dines said. "Anything they can do, they'll try."
Jeter's ankle injury might have some latent impact on certain elements of his play, such as his already diminished lateral movement at short and, perhaps, his most famous hitting technique. "It could affect his ability to hit to the opposite field with precision and power, because less-than-perfect left foot and ankle strength and mechanics could have an effect on balance and strength when driving the ball to right," Positano said. Still, it is unlikely to hamper Jeter severely as he tries to make it through last season. Something else might, though, and there is nothing that he or his doctors can do about it.
There is a reason why there will likely be just four position players older than Jeter in the majors this year (Jamey Carroll, Jason Giambi, Raul Ibanez and Ichiro Suzuki), and why just three men who were 40 or older have ever played more than 100 games in a season at shortstop (Luke Appling, Omar Vizquel and Honus Wagner). Many of the body's structures have become less elastic by the time a person reaches Jeter's age, and less resilient to a grueling athletic schedule. Positano is particularly concerned about Jeter's plantar fascia and Achilles tendon. "The problem with the Achilles is that after age 30, the blood supply to it is reduced by an additional third," he said. "It's the largest tendon in the body, takes the most abuse, has the least blood supply and the least elasticity."
Added Dines, "By nature of his age, he's going to be at a high risk for overuse injuries, which also include meniscus tears and hamstring pulls -- little thing that are annoying, but happen, and now he won't recover as quickly. The ankle fracture isn't going to help him, but he's had enough time to heal, and he should be good, generally. Now he has to deal with the fact that he's 40 years old and playing a full season. He knows what he's in for."
Even so, both doctors believe that if anyone can beat the odds, it is Jeter. "Knowing the type of care he's gotten, I think he's going to come back very strong," Positano said. "He's going to shut a lot of people up. I think you're going to see a resiliency here that this person's always had. To have that type of success in professional sports requires unbelievable focus and dedication. He's going to apply that to his rehabilitation, to maintaining the strength and stability he needs to become effective again."
"I believe in the power of the mind," Jeter told ESPN last week. But as he has surely discovered over the last 18 months, there are some things over which the mind has little control. From a clinical perspective, however, the Yankees' once-hobbled shortstop has a fair chance of achieving what he desires, which is to deepen a legacy that is still, for one more season, a work in progress.