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Burney's Road To Recovery Could Be Long

On Thursday, the team announced that sophomore forward Jerome Burney would miss the remainder of the season due to a broken sesamoid bone in his right foot. When I heard the news, several questions immediately came to mind:

What on earth is a sesamoid bone and what is its purpose?

Is this a continuation of the injury Burney had in his right foot earlier this season or an entirely new problem?

How long will Burney be out this time?

I turned first to Gary Williams, but he reminded me he's not a doctor and kindly suggested I speak with J.J. Bush, the team's trainer. That, as it turned out, was a great idea.

When I went to Bush yesterday, he briefly retreated into his office inside the training room and returned with a thick text book entitled "Arnheim's Principles of Athletic Training." He flipped straight to a page with a diagram of the foot's bone structure and pointed to the origin of Burney's newest health issues.

Bush said Burney broke the two sesamoid bones on the bottom of his big toe. They're located in the crevice where the bend takes place. Each are roughly the size of a pea.

"What they do is they increase the mechanical advantage or leverage," Bush said. "So like if you had a big rock sitting on the table and you got a pole and tried to move the rock, if you took another something and put it under the middle of the pole to create leverage, then you can lift the rock up a lot easier. That's what those little bones do. They're the mechanical advantage."

"Sesamoid," according to Bush, literally means "a bone within a tendon." He said the tendon under the big toe runs underneath the foot muscle and then goes through the sesamoid bones, which increases the leverage -- the mechanical advantage -- used to extend the toe.

Bush said you can fracture sesamoid bones numerous ways: Through the stress of bending your foot really hard or by landing forcefully on a hard surface, like, say, when you're coming down with a rebound.

"The problem is, because they're very dense bone, they don't have a real good blood supply," Bush said. "In other words, if you look at most bones, they have a marrow running down the middle of them, like a chicken bone or something. Well (sesamoid bones) are very dense; they don't have much marrow. Marrow is where the blood vessels are, where the nutrients that feed the bone cells are. So when you break that thing, many times it doesn't heal very well."

The worst case scenario, Bush said, is that the sesamoid bones don't heal at all. If the bone lacks proper nutrition, necrosis ("Bone death," Bush explained.) occurs. And if that happens, Burney might have to have the broken sesamoid bones completely removed.

Bush said 50 percent of a person's body weight is directed toward his or her big toe. He demonstrated by taking an exaggerated step forward.

"When you walk, your heel strikes the ground first, then the weight goes to the outside of your foot and then when you go in to toe-off, it goes back to the inside, mostly onto your big toe," Bush said. "So when you take that thing out, if it has to be taken out, the foot doesn't function as a lever as well because you've taken out that little bone. In (Burney's) case, hopefully it will heal fine."

One option, Bush said, is to put a tiny pin or a little piece of wire across the sesamoid bones to hold the two edges together. That, he said, sometimes aids the healing process.

That's a secondary option, though, according to Bush. Right now, he said, they're treating Burney's injury "very conservatively."

"We've got him on crutches so he's not bearing any weight on that area, and we've got him in the boot so he can walk with his weight on his heel and not put any weight on the ball of his foot," Bush said.

Sesamoid bones can take longer to heal than others, Bush said, because they don't receive good blood supply. He said that if the break was to the big toe bone, to which blood supply is stronger, recovery time would be in the 4-6 week vicinity.

Bush said Burney will undergo a CT scan in about four weeks to examine how the healing is taking place.

Sesamoid bone breaks are not all that common. Bush said he and the Maryland training staff probably treat five or six such cases per year.

As for Burney's injury, Bush said it is completely different from the stress fracture he suffered earlier this season. "We're talking about apples; the other one was oranges," he said.

The injury occured during practice on Feb. 27. Bush said Burney was participating in a drill and felt a pop when he pushed off the foot. Burney continued to practice and then reported the pain to Bush afterward. Bush immediately treated the injury with ice.

The team left for Raleigh, N.C. the following day in advance of the game at N.C. State on Sunday. Burney did not play against the Wolfpack. Due to the snow storm on Monday, Maryland's health center was closed, which meant Burney had to wait until Tuesday for X-rays. Bush said he took Burney to see Dr. Craig Bennett, Maryland athletics' head team physician, on Thursday for further examination.

"Hopefully," Bush said once more, "it will be fine."

By Steve Yanda  |  March 7, 2009; 11:03 AM ET
Categories:  Men's basketball  
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Comments

Great piece Steve. Thanks for the info. I thought perhaps this would explain why Jerome did not get off the bench for the Duke game. Since the injury did not occur until the 27th, I'm still left to wonder why Gary didn't use him with Duke killing MD on the offensive boards. In any case, I wish Jerome the best and hope he can make it back. He is the type of player that can help this team in the next couple of years off the bench. Good luck to him and GO TERPS! 8-8 in the conference and a first round tourney match up against beatable BC or VT teams should get MD back in the NCAA's.

Posted by: virtueandvice | March 7, 2009 11:35 AM | Report abuse

About two weeks ago I read an article in the NY Times about a treatment that may accelerate Burney's healing. Because bones have a limited blood supply, healing takes place very slowly because certain blood cells generally rush to an injury and promote healing by beginning a cascade of physiological responses. It is experimental, but in a few cases doctors have tried injecting the injury site with a concentrated amount of the patients own blood cells (I think platlets, but I'm not sure) to accelerate the body's healing ability at that specific site.

Posted by: jandrews1 | March 7, 2009 6:08 PM | Report abuse

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