The Extensive History of Deron Williams’ Ankle Issues and the Associated Uncertainty

The Nets announced Tuesday that All-Star point guard Deron Williams received injections of both cortisone and platelet rich plasma (PRP) in his troublesome left ankle. He received the same injections in his right ankle and his long-term status will be determined following an additional evaluation scheduled for later in the week.

These rounds of injections are just the latest setback for Williams, whose ankle problems date all the way back to his first year in the league. During his rookie season, Williams suffered sprains to both ankles but only missed one game. He would remain relatively healthy for the next two years until suffering a Grade II sprain to his left ankle during the 2008-09 season. The injury initially cost him six games and he would sit an additional seven with lingering soreness. He sprained the left ankle again in 2009-10 but appeared to put his ankle problems behind him with his move to Brooklyn. However prior to last season, the pain and soreness resurfaced and he was diagnosed with synovitis caused by bone spurs in his left ankle.

The pain continued and he eventually was diagnosed with synovitis in his right ankle as well. His on-court productivity dipped as Williams received at least eight cortisone injections to help with the inflammation. He underwent a PRP procedure prior to the All-Star break and returned invigorated, averaging 22.9 points and 8.0 assists after the break.

After a flurry of offseason moves that landed Kevin Garnett, Paul Pierce, Jason Terry, and others, Williams appeared poised to lead the Nets to Eastern Conference contention. However the ankle issues reappeared during an offseason workout session that left Williams with a sprained right ankle and bone contusion. He would miss time during the preseason but be in the lineup for the first game of the season. Williams suffered a left ankle sprain in mid-November and aggravated the injury in the following game.  He would sit two games but his return would last a mere 13 minutes. He rolled the ankle yet again and would sit nine more games.  Now 13 games later Williams is again sidelined and receiving injections.

Given the information provided by the team, it seems possible that Williams’ synovitis has returned. The fact that both ankles received the injections means it’s likely more than a simple ankle sprain. The ankle joint contains a synovial membrane, a layer of soft tissue that acts as a cushion between spaces within the joint. Unfortunately the synovial tissue can become inflamed and disrupt the normal function of the affected area. The cortisone injection Williams received is an anti-inflammatory injection designed to minimize the associated inflammation, and as a result any pain he is experiencing. The PRP infusion is an attempt to accelerate the healing process using D-Will’s own blood.

In the procedure, a sample of the athlete’s blood is taken and broken down in a machine known as a centrifuge.  A protein-concentrated mixture is taken from the sample and injected into the ankle. The PRP mixture is filled with the main component of blood responsible for clotting, a substance known as platelets. By increasing the platelet count the body’s natural healing response is able to work quicker and more efficiently.

However ESPN’s Mike Mazzeo raises an interesting point. Mazzeo points out that Williams reportedly never underwent a debridement procedure to remove the previously diagnosed bone spurs as he had said he would.  If the bone spurs do indeed remain within the ankle, they may be the culprits behind Williams’ chronic inflammation. Without removing the spurs, Williams will remain vulnerable to inflammation and pain in the ankle when the effects of the current round of injections subside. Couple that with the associated damage to the ligaments from his numerous sprains and it becomes hard to imagine this is something Williams will overcome quickly.

Look for the Nets to rest Williams for an extended period of time before easing him back into the rotation. The team travels to London on January 16 to take on the Hawks and it will be interesting to see if Williams makes the trip. With Brook Lopez done for the season and Williams unlikely to shake his ankle issues, the once firm foundation of the Nets looks a lot less stable than it did three months ago.

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