The Minnesota Twins are off to a great start this season, due in part to a fantastic 5-1 start from pitcher Ricky Nolasco. Unfortunately, Nolasco is currently on the disabled list with an ankle issue, and he recently had a setback during a rehab session. The Twins note that Nolasco is dealing with an ankle impingement issue, so we thought we’d examine the condition and discuss Nolasco’s injury.
Ankle Impingement Syndrome
Ankle impingement is categorized as a painful mechanical limitation of a person’s full ankle range of motion, typically caused by a previous or related soft-tissue injury. This is the case for Nolasco, who was diagnosed with an ankle impingement related to an injury he suffered in high school.
Ankle impingement is generally caused by an injury, like an ankle sprain. When you sprain your ankle, your body responds by attempting to heal the ruptured/torn ligaments. When too much scar tissue forms, movement of the ankle can trap tissue between the edge of the ankle joint, causing pain and discomfort. Additionally, ankle sprains can cause bone spurs to develop over time. These spurs can form along the bottom of the tibia bone or the upper surface of the talus. As the ankle moves, the bone spurs can push into the soft tissues along the front edge of your ankle joint, causing an issue known as anterior ankle impingement.
Although we don’t know exactly what happened to Nolasco in high school, as we documented in a previous post, ankle sprains and fractures are common, especially when a player slides into a base. It’s safe to assume a similar injury happened to Nolasco, and his impingement issue has slowly developed over time. One of the bigger problems for Nolasco is that his injury is located in his right foot. Nolasco is a right-handed pitcher, which means he uses his right foot to drive off the mound and excel towards home plate. Most pitchers derive their power from their lower body during this push-off sequence. Nolasco clearly wasn’t able to do this well during his rehab session, as Twin pitching coach Neil Allen had this to say:
“It was just all arm. He couldn’t drive.”
Treatment of Ankle Impingement
So what can be done for Nolasco and anyone else suffering from ankle impingement? In the short-term, a person may experience some symptom alleviation with rest, cortisone injections and anti-inflammatory medications, but that’s not going to fully correct the problem. The Twins hoped Nolasco would respond to conservative treatment, as he has been resting and he received a cortisone shot, but he’s still experiencing symptoms while pitching.
Surgery is a better option to fully resolve the problem. Ankle debridement is the most common surgery for anterior ankle impingement. This is a minimally invasive procedure that removes the irritating tissues or problematic bone spurs. After an ankle debridement, a person is generally uses crutches for a week or two, but weight bearing increases rather quickly. Most people can be back to full activities within four to six weeks.
It seems likely that Nolasco would benefit the most from a simple ankle debridement procedure. He’d likely only miss a little over the month, and with the All-Star Break looming, he would only miss 33 games if he sat out the next six weeks. This would give him plenty of time to return ahead of a late season playoff push.
Whatever route he chooses, I wish Nolasco the best of luck in his recovery.