It’s seen in men and women; the elderly and the young; the athlete and couch potato. So what is it and what to do?
Lately, Antonio Gates, the future Hall of Fame tight end for the San Diego Chargers, has been felled by this common, yet potentially complex problem. Having already missed several games near the end of last season, he now has missed several more games so far this year!
The plantar fascia is a band of tissue starting at the base of the heel and splaying out, like the branches of a tree, toward the toes. It is made of collagen fibers similar to a tendon and helps support the arch. So it takes significant strain all day long.
Most of us over 30 have felt some of its symptoms at the bottom of the heel. The pain is usually worse first thing in the morning with the first steps of the day or after one has been sitting for some time and then stands up. As the sufferer “warms up” the pain dulls down, but may not go away completely. Surprisingly, the symptoms are generally self-limited and go away on their own. The big question is when? For some, it may be just a few days. But for others, it may be as long as a year!
A plantar fascia tear can occur, with the fascia’s attachment to the heel tearing away completely. While this may actually stimulate healing, this can take a long time and requires extended immobilization.
The pathology seems to be an area usually near the origin of the plantar fascia at the heel that has micro-tears with inflammation. This can occasionally end up with a poorly organized scar tissue deposition in the area leading to chronic problems. Generally, treatment is non-operative. Non-steroidal anti-inflammatories (NSAIDS), stretches of the plantar fascia and Achilles tendon, night splints (for prolonged stretching while asleep), and custom orthotics to support the arch and plantar fascia can be quite helpful.
Steroid shots to the area of pain can provide quick relief by acting as an anti-inflammatory right to the site of the pain. But there is a possibility that they may actually prevent true recovery by decreasing the inflammation needed for healing, causing atrophy and tearing of the plantar fascia. Platelet-rich plasma (PRP), drawn from the patient’s own blood, may be a safer and more effective option to stimulate true healing but more research is needed before it should be used routinely.
Surgery involves a partial release of the plantar fascia using a small scope and knife blade, essentially injuring the area to stimulate healing. However, this too can have side effects, and should be a last option.
So what happened to Antonio Gates last year and now this year? There has not been much information put out in the press other than “foot pain”. But it is clear this is more complicated than a standard case of plantar fasciitis.
He was having trouble early last season, while recovering from a left toe injury. This was probably putting increased pressure on his right foot. In October of last year it was reported he had a plantar fascia tear, which can be difficult to recover from.
Sometimes, when the plantar fascia is completely torn (or cut on purpose in surgery) there is a subtle arch drop that leads to a troublesome pain on the outer aspect of the foot (lateral column syndrome). This pain may take up to six weeks to resolve in a walking boot. I suspect this may have happened to him.
He tried playing through it, but was shut down in December and rested it through the offseason. It has been reported that he has now torn the scar tissue and is probably out another couple of weeks.
In a high-level athlete like Gates, it may be something that comes and goes for the rest of his life. “It’s the worst feeling in the world,” Gates had said last year. “Sometimes you feel your career is coming to an end!”
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