Plantar Fasciitis: Foot Pain Affecting Millions of Americans (and even Eli Manning)



Posted: Thursday, October 08, 2009

by
Indiana Podiatry Group

Recently NFL quarterback Eli Manning has developed plantar fasciitis. Anyone who has developed this condition is well aware of it, however many Americans do not fully understand the basics of this very common cause of heel and arch pain. Eli Mannings injury during a game brings to light a less common cause of plantar fasciitis, but millions of Americans develop this condition without having to injure it on the playing field. This article will discuss this common condition, and how it is properly treated.

Heel and arch pain is caused by many different conditions. The most common type of heel pain is caused by inflammation in a ligament called the plantar fascia. The pain in this condition is located on the middle bottom of the heel or along the back of the arch where it meets the heel, and is usually present in most people upon first arising in the morning or after arising from a seated position. Plantar fasciitis, as it is called, is seen in those with flat feet and in those with high arches. Flat feet, which are usually the cause of this condition, allow for chronic stretching and tearing of the fascia where it attaches to the heel bone. The foot does not have to be severely flat for this to occur, as moderate flattening can cause damage also. As a result of this stretching, a spur can form along the line of traction of the fascia off of the heel bone. This spur is often misunderstood to be the source of the pain, whereas it is usually completely painless as it is positioned in the direction of the ground, and not poking down into it. High arches, another common cause, allow for abnormal shock to be transmitted to the heel with every step. Direct injuries or traumatic tearing of the tissue (either miniscule, partial, or complete), though less common, can also cause inflammation to the plantar fascia. What often will happen is that someone will step on a rock or another blunt surface, which then causes significant irritation to the fascia directly through the contact. The fascia can also be torn by a strong force pushing up on the front of the foot, such as when someone tries to carry a heavy weight up the edge of a stair or the rung of a ladder.

Though possibly self-healing over a long period of time, this condition can last for many years when no treatment is given, and can make activity nearly impossible. For treatment, a combination therapy of inflammation reduction with anti-inflammatory medications, steroid injections, icing and stretching is necessary, along with arch support through prescription shoe inserts (orthotics) to stabilize and support a flat foot or provide shock absorption to a high arched foot. Only rarely is surgery required.

Eli Manning's injury may be the result of long term damage to his plantar fascia from his foot structure, which reached a breaking point during his pass attempt, or he may have planted his foot with enough abnormal force to partially tear or otherwise disrupt the fibers of the plantar fascia. Regardless, the needs of a high-level athlete for treatment of this condition may be different from most other people. The key to his recovery is firstly stabilization, and then inflammation/pain control. The fascia must be stabilized immediately for him to continue to play without significantly causing further injury and prolonging recovery. Specialized arch taping is important. Orthotics to replace the taping can follow once his inflammation is reduced, but the taping will provide great on-field support. Inflammation control will soon follow, to allow him to comfortably compete. However, for most 'regular' patients not competing professionally, inflammation control is key for the initial treatment step, followed by support soon after. The use of a steroidinjection(cortisone-like medication, not a bodybuilding steroid) seems to have the most immediate impact on patients, although the reduction in inflammation can take up to a week to occur after the injection and up to three injections may be needed, best split two weeks apart. Anti-inflammatory medications, like strong prescription versions of ibuprofen-like medications, also help reduce the body's overall state of inflammation, reducing pain further. Although generally safe, they are not to be used in those with severe stomach conditions (like ulcers), those with kidney damage, and those with serious heart disease. Pain medications like narcotics or even Tylenol are not be a good idea, as this simply blocks the feeling of pain and does not reduce the cause (which is inflammation). One essentially walks on the injured foot without a sense of limitation, leading to further injury. Inflammation control will reduce the pain, and help heal the injury as long as it has not reached a chronic stage of scarring and ongoing inflammation called fasciosis. This is seen in fasciitis cases that do not get treated for a long while. When this is the case, physical therapy to return the fascia to an acutely injured state will eventually allow the tissue to heal. In regards to structural support, the use of heavy duty over-the-counter inserts followed soon by orthotics seems to be a better choice than the taping a high-level athlete will receive, as taping eventually loosens and falls off and most people do not have a training staff at home to replace this regularly. Finally, icing of the arch and heel to decrease more inflammation will be necessary, especially before and after activity, as well as stretching of the arch and calf to make the bottom of the foot more limber, reducing damage to the fascia.

Eli Manning will recover just fine from this condition like millions of Americans do every day. The key for him is proper treatment, starting now. For those with this condition, the same principles apply, although their fasciitis has likely occurred because of the shape of the foot combined with daily regular activity, and not a specific injury event . One does not need to perform at the activity level of a world class athlete to require treatment. Getting rid of the pain just to simply return to work comfortably should be all the motivation one needs to get proper medical attention.

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Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at www.inpodiatrygroup.com
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