PHILADELPHIA — Even before he stepped into his Los Angeles office to deliver the diagnosis that changed everything about this year's NBA draft, that might yet change everything for the Philadelphia 76ers, Dr. Richard Ferkel already had taken the measure of the sweet, 7-foot-tall kid who would soon lie on an operating table in front of him.
In an exclusive interview with The Inquirer, his first since performing the surgery that is supposed to salvage the career of Joel Embiid, Ferkel described in depth the nature of Embiid's injury and the process by which he will treat it. More, he sounded a note of optimism that the Sixers were right to select Embiid with the draft's No. 3 pick and wait for him to recover from a stress fracture in the navicular bone in his right foot.
By his own estimation, Ferkel has done between 20 and 30 navicular-fracture surgeries, and in terms of the injury's severity and the patient's likelihood for a full recovery, he said that Embiid's situation was far from the worst of those.
"Once he's fully healed, his chances of having a long career are very good," Ferkel said in a phone interview. "There's no reason he shouldn't have a great NBA career and be very successful. Once this heals, hopefully this won't be an issue for him in the future."
The director of the sports medicine fellowship program at Southern California Orthopedic Institute, Ferkel has repaired some of the most famous feet in basketball, allowing the likes of Ray Allen and Manu Ginobili to extend their careers into and beyond their mid-30s. Player agents and team doctors seek him out for both his sure hands and his expertise, and after Embiid had complained of pain in his right foot during a predraft workout in Cleveland, Embiid's agent Arn Tellem had called Ferkel to arrange an appointment.
Now it was Tuesday, June 17. Tellem had provided Ferkel with the results of tests that doctors in Cleveland had conducted on Embiid's foot, and Ferkel had examined Embiid himself just a few days earlier, performing his own tests before probing Tellem for insight into Embiid's personality and background.
"Twenty years old. ... Had played just one season of college basketball at Kansas. ... From Cameroon. ... Parents are still there, so no family support group here. ... Be realistic, but positive. ...
Once Ferkel began to speak, he could see the shock spread over Embiid's face. He wanted to insert two screws into Embiid's foot to stabilize it, then have him begin a rehabilitation program that would last five to eight months. The news left Embiid crestfallen, Ferkel said, fearing for his future in the sport, until Ferkel explained that there was no need for panic. In that moment, Ferkel might as well have been talking to Sixers general manager Sam Hinkie, the rest of the team's power people, and a fan base forever seeking reassurance that the sky wasn't about to come crashing down.
Embiid sustained what Ferkel called a "clean break" of the navicular - a weight-bearing bone in the middle of the foot - "without any major separation, which is important." Here's why: Navicular fractures can be notoriously difficult to diagnose, in part because they're not easily identified on an x-ray, in part because the symptoms are often so vague that the patient can't pinpoint the pain's origin. If the athlete continues to play, subjecting the foot to more pounding and trauma without realizing it's been fractured, the two sides of the bone can move apart and harden at the break, inhibiting healing. The fracture widens and deepens. Fluid-filled cysts can develop within the bone.
But Ferkel diagnosed Embiid's injury so soon after Embiid had broken his foot that none of those potential side effects presented itself. Ferkel operated on Embiid on June 20. Soon after, eight to 10 NBA teams with realistic chances of drafting Embiid, the Sixers among them, requested copies of Embiid's medical records. If Embiid had been the consensus No. 1 pick before the injury, he wasn't anymore, not with Andrew Wiggins and Jabari Parker having clean bills of health. So the two teams ahead of the Sixers in the draft took safer routes: The Cavaliers selected Wiggins; the Milwaukee Bucks selected Parker. And Hinkie, who'd had Nerlens Noel sit out a full season after knee surgery, was willing to be patient with another player whom he judged to be a franchise centerpiece.
"He is a remarkable talent," Hinkie said, "and in our minds, in only this scenario does he fall to 3."
Embiid's rehabilitation will proceed in stages. He's in the midst of a six-week stretch during which he cannot put any weight on the foot. From there, he'll don a specialized boot and train both in a swimming pool and on an antigravity treadmill. After 12 to 16 weeks, he'll begin a running program, and Ferkel will use an ultrasound stimulator on him to hasten the bone's growth and healing.
Hinkie hasn't said for certain whether Embiid will play during the 2014-15 season, choosing to be as cagey as he was about Noel. Given the familiar history of big men whose careers were truncated by leg and foot problems - Bill Walton, Sam Bowie, Yao Ming, Greg Oden - it would seem understandable for the Sixers to be as prudent as possible.
Just understand: Ferkel made it clear that, assuming there are no setbacks, a five-to-eight-month rehab period should be enough to have Embiid physically ready to return to the court by late February at the latest.
"It's certainly possible that he could come back this season," Ferkel said.
If he doesn't, there ought to be no doubt about the lengths that Hinkie and the Sixers will go to preserve a better opportunity for another top-three draft pick.
But then, this coming season was always going to be just the next phase of the Sixers' rebuilding, and since that sit-down with Ferkel, since he heard the news that shook him to his core, Embiid hasn't appeared inclined to worry about his foot or his future.
On June 20, he posted a series of photos on his Twitter account, offering a glimpse into what might prove the most consequential day of his career. There he was, wearing an oxygen mask and a hair net, lying on a hospital gurney, making silly faces, joking that he "wasn't even asleep while they were doing the surgery."
He had turned his body and basketball life over to Richard Ferkel, and Joel Embiid's mind was at ease. For now, everyone else's ought to be, too.
ABOUT THE WRITER
Mike Sielski is a columnist for the Philadelphia Inquirer.