Diagnosing And Treating Common Baseball Injuries

Matthew B. Werd, DPM, FACFAS

As spring yields to summer, more baseball players may present to your office with injuries sustained while batting, sprinting around the bases or sliding into home. Accordingly, this author presents a guide to treating common forefoot, midfoot and rearfoot injuries as well as contusions and dermatological conditions.

Springtime brings warmer temperatures, the anticipation of summer and the start of a new baseball season. We welcome spring baseball with the crack of the bat but it can also lead to an unwelcomed crack of the bones and other baseball-related injuries. As sports medicine specialists of the lower extremity, we should be able to accurately diagnose and appropriately treat lower extremity injuries in order to return the injured baseball player to the diamond as quickly and safely as possible.

   We should also recognize the full scope of baseball’s popularity and trends. Organized baseball in the United States is now among the most popular and safest sports. Over 20 million people play annually. The majority of baseball players are children and adolescents with an estimated 8.6 million children ages 6 to 17 participating.1,2 Baseball is one of the safest high school sports in the United States with a reported injury rate of 1.26 injuries per 1,000 athletic exposures.1 Although baseball is a relatively safe sport in comparison to many other athletic activities, highly publicized occasional catastrophic injuries (such as commotio cordis) from the direct impact of a ball or bat frequently raise safety concerns.1

   The U.S. Consumer Products Safety Commission reports that in 2012 more than 400,000 Americans had treatment in hospitals, doctors’ offices and hospital emergency rooms for baseball-related injuries.1 Nearly 300,000 of the players treated were 18 years old or younger. Although baseball is a non-contact sport, most serious injuries are due to contact — either with a ball, bat, or another player. Eleven- to 14-year-old children represent the majority of those injured and the most frequent areas of the body injured are the head and face, including the eyes and nose. Nearly 20 percent of baseball injuries occur at the lower extremities and injuries to the foot and ankle can cause significant disability if one does not diagnose and treat them appropriately.1

   Many young athletes are now focusing on just one sport and are training year round, causing an increase in overuse injuries at younger and younger ages. We should encourage youth athletes to play multiple sports and activities, and to take time off from only playing one single activity year round. Safety of the athlete is a constant focus of attention among rule-making officials and governing bodies. Subsequently, youth baseball rules control the maximum pitch count, required rest periods and age recommendations for throwing various types of pitches. Additionally, important factors in minimizing the risk of injury include appropriate field maintenance and awareness of environmental conditions such as extreme heat, thunderstorms and lightning.3

   Injury patterns may change with the level of competition from youth to high school, and college to minor and major leagues. It is critical for sports medicine physicians to identify and appropriately treat baseball injuries in a timely manner. Youth baseball injuries need evaluation with special concern for open growth plates whereas minor and major league injuries are often more chronic due to the overuse from extensive daily repetitive training regimens.

   Equipment considerations in the prevention of baseball injuries should include a position-specific evaluation of cleats, socks, bats, helmets, insoles, orthoses, field conditions and even fixed versus breakaway bases.4 Installing breakaway bases on all playing fields may significantly decrease sliding injuries.2


Sunny greetings! Excellent article. Timely, informative and inspiring to PLAY BALL!

Congratulations, Dr. Matt and to the fabulous picture of our sliding into home safe athlete, Matthew! Wow, what a coup to land on the front cover and looking handsome as ever!

What a grand, thorough and scholarly article. It hits the mark for a perfect score. A blue ribbon winner. Very interesting to know the high safety records of playing baseball and the various types of treatable accidents.

Emphasizing diversity in sports for young athletes ranks as high importance. Great to see this highlight along with many other interesting points. The x-rays were fascinating as well. Being aware of the environment, field conditions and general heat conditions remains overlooked in the zeal of the day.

Sending all a very HAPPY SUMMER indeed with safe play and lots of fun. Again, a solid home run hit with the article! To the top surgeon: CONGRATULATIONS!

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