05/07/2013    Ed Davis, DPM

Laker Basketball Star's Injury May Have Been Preventable: TX Podiatrist (Brian Fullem, DPM)

How can Dr. Fullem make the remarks about my
original communication when he has not read it?
The Wall Street Journal story extracted
information from my email communication,
particularly those items that were of heightened
interest due to the recent Achilles rupture by
Kobe Bryant. It contains less than 30% of the
original content.

There are many theories as to the cause of
Achilles rupture but since we generally see
patients after rupture occur, formation of
studies to provide the level 1 evidence mentioned
by Dr. Fullem are scarce. I cited two
references that supported the role of a tight
Achilles tendon or functional equinus as an
etiology. Please re-read Dr. Richie's statement
as he was the one who made the assertion that “we
are all aware that there is no evidence.” There
is a paucity of level one evidence to support
much of the biomechanics we use in practice but
that does not invalidate such concepts.

Remember that biomechanics is based on mechanics.
Concepts such as tensile strength, strain,
elastic modulus, torsion and deformation arise
from general mechanics. Materials placed under
excess tension or torsional strain are more
likely to fail. Biomechanics cannot violate basic
laws of mechanics. According to Wheeless' Texbook
of Orthopedics, “mechanism usually involves
eccentric loading on a dorsiflexed ankle with the
knee extended (soleus and gastroc on maximal
stretch).”

Dr. Fullem goes on to state, “I gathered from Dr.
Davis' quotes was that Kobe Bryant's Achilles
injury could have been prevented by stretching.
Nothing could be further from the truth.” Dr.
Fullem, please do not make things up. I never
made such a statement.

Additionally, Dr. Fullem states, “I would also
assume that Dr. Davis does not have his patients
perform eccentric strengthening which has been
proven in many studies to work.” What does he
base this on? We use eccentric stretching
frequently.

Ed Davis, DPM, San Antonia, TX,
ed@sanantoniodoc.net

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