If you watched the 2024 World Series, you saw more than just a historic walk-off grand slam. You saw a masterclass in grit. Freddie Freeman, playing on a severely swollen right ankle, managed to power the Dodgers to a title despite being visibly hobbled.
But adrenaline only lasts so long. Once the champagne dried, the reality of the anatomy set in. In December, the headlines confirmed what many of us in the sports medicine world suspected: Freeman required surgery. specifically, 'debridement and the removal of loose bodies.'
For the elite athlete and the 'weekend warrior' alike, this phrase, removal of loose bodies, is a common but often misunderstood diagnosis.
At Prisk Orthopaedics and Wellness, I see this story play out constantly. You don’t have to be a World Series MVP to feel that sharp, locking pain in your ankle. Today, let's break down exactly what happened to Freddie's ankle, what a 'loose body' actually is, and why ankle arthroscopy recovery is the gamechanger that gets athletes back for Opening Day.
The 'Pebble in the Shoe' Phenomenon
Imagine walking with a small pebble in your shoe. It’s annoying, right? Now, imagine that pebble is inside the joint, floating between your ankle bones. Every time you flex your foot to take a step or round a base, that pebble gets caught in the gears of the joint.
This is exactly what a loose body is.
What Are Loose Bodies?
Loose bodies are typically small fragments of bone or cartilage that have broken off from the main joint surface. In an athlete like Freeman, who has likely put thousands of miles on his joints, these can occur from:
- Trauma: A severe sprain (like Freeman sustained in late September) can chip the cartilage or bone.
- Osteochondritis Dissecans (OCD): A condition where a segment of bone and cartilage separates from the underlying bone.
- Chronic Wear: Repetitive impact can cause osteophytes (bone spurs) to break off.
When these fragments float freely, they cause loose bodies in ankle symptoms that are distinct from a standard sprain. Patients often tell me, 'Dr. Prisk, it feels like something is getting stuck.' You might experience:
- Locking or Catching: The joint physically freezes up momentarily.
- Clicking Sounds: Audible crepitus as the fragment moves.
- Sudden Sharp Pain: Unlike a dull ache, this is a 'zing' when the loose body impinges on the joint lining.
- Swelling: The joint produces excess fluid (effusion) trying to flush out the irritant.
The 'Nutcracker' Effect: Anterior Impingement
In many cases, loose bodies are accompanied by Anterior Ankle Impingement, often called 'Footballer’s Ankle' or 'Baseballer's Ankle.'
Repeated upward bending of the ankle (dorsiflexion), think of a catcher in a squat or a sprinter in the starting blocks, causes the tibia (shin bone) and the talus (ankle bone) to collide. Over time, the body reacts by forming bone spurs. When these spurs break off, they become loose bodies.
(For a deeper dive into the opposite problem, pain in the back of the ankle, check out our article on Posterior Impingement in Ballet.)
The Solution: Ankle Arthroscopy (The 'Clean Up')
When Freddie Freeman’s medical team announced 'debridement,' they were referring to a procedure I perform frequently: Ankle Arthroscopy.
Unlike open surgery, which requires large incisions and detaching muscles or ligaments, arthroscopy is minimally invasive. It is the gold standard for ankle impingement treatment and removing loose bodies.
How It Works
- Portals: We make two tiny incisions (about 3 mm each) in the front of the ankle.
- The Camera: Through one portal, I insert an arthroscope, a camera about the size of a thin 2.4 mm straw. This projects a high-definition view of the ankle interior onto a monitor.
- The 'Vacuum': Through the second portal, we use specialized instruments. We might use a grasper to remove large loose bodies (like picking up that pebble) or a shaver (essentially a medical-grade vacuum) to smooth down fraying cartilage and suction out smaller debris.
The goal is to restore the smooth gliding surface of the joint. We aren't just removing the loose debris; we are also smoothing rough edges of cartilage (chondroplasty) and removing inflamed scar tissue (synovectomy).
For a more detailed look at how we address cartilage specifically, read about Restoring Mobility: Arthroscopic Ankle Cartilage Surgery
Ankle Arthroscopy Recovery: Why It’s Fast
The reason Freeman could have surgery in December and confidently expect to be ready for Opening Day lies in the minimally invasive nature of the procedure.
Ankle debridement surgery via arthroscopy preserves the structural integrity of the ankle. Because we don't have to cut through major stabilizing ligaments to get inside, the recovery timeline is drastically shorter than open reconstruction.
The Typical Timeline
While every patient is unique, here is a general roadmap for a 'clean up' surgery:
- Day 0 (Surgery): Outpatient procedure. You go home the same day. You’ll be in a soft bandage and possibly a boot.
- Days 1-3: 'Rest and Elevate.' You might use crutches for comfort, but many patients can bear weight as tolerated in the boot immediately, depending on the specifics of the work done.
- Week 2: Stitches come out. Physical therapy begins to restore range of motion. The focus is on getting the swelling down.
- Weeks 3-6: Ramping up. We transition from the boot to a brace. Strengthening exercises begin. For a pro like Freeman, this is when they start hitting off a tee.
- Weeks 6-12: Return to sport. Running, cutting, and jumping are introduced progressively.
Compare This to Open Surgery
If Freeman had required a full open reconstruction or ligament repair, he would have been protected for longer. Opening Day would have been off the table. The arthroscope allows us to fix the mechanical problem without creating a new surgical trauma.
When Is Arthroscopy NOT Enough?
It’s important to manage expectations. Arthroscopy is fantastic for mechanical symptoms, the clicking, locking, and catching caused by loose bodies or spurs. It is a 'clean up.'
However, it is not a time machine.
If the ankle has significant arthritis (loss of the cartilage cushion), removing the loose bodies will help the mechanical locking, but it won't cure the deep, aching pain of arthritis. In cases where there is massive cartilage damage, we might need to discuss more advanced cartilage restoration techniques or, in severe cases, joint replacement or fusion.
But for the athlete with a specific injury and 'floating chips,' the scope is the MVP of procedures.
The Takeaway: Don't Play Through the Click
Freddie Freeman played through pain to win a World Series. That’s the nature of professional sports. But for the rest of us, the high school shortstop, the recreational runner, the weekend hiker, ignoring a locking or clicking ankle can lead to more damage.
Those loose bodies are like sandpaper inside your joint. The longer they float around, the more healthy cartilage they can scratch and damage.
If your ankle feels like it’s catching, or if you have persistent swelling after an old sprain, you might need a 'clean up' job.
At Prisk Orthopaedics and Wellness, we specialize in getting you back on your feet, whether your goal is Opening Day or just walking the dog without pain.
Experiencing ankle locking or pain?
Schedule a consultation at Prisk Orthopaedics and Wellness today.
