I'll review plantar fasciitis for those of you new to this blog. 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. 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. 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 the hundreds of patients I treat each year for this condition in his brother's home city of Indianapolis. The key to his recovery is firstly stabilization, and then 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. For most 'regular' patients not sprinting around on turf, the use of heavy duty over-the-counter inserts followed soon by orthotics seems to be a better choice, as taping eventually loosens and fall off and most people do not have a training staff at home to replace this regularly. 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. The use of a steroid injection (cortisone-like medication, not a bodybuilding steroid) seems to have the most immediate impact on my 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, also help reduce the body's overall state of inflammation, reducing pain further. Pain medications like narcotics or even Tylenol will not be a good idea, as this simply blocks the feeling of pain and does not reduce the cause (which is inflammation). Eli Manning would simply run without pain, but this would lead to a dramatic worsening of his condition. Finally, icing of the arch and heel to decrease more inflammation will be necessary, especially before and after a game or practice, as well as stretching of the arch and calf to make the bottom of the foot more limber, reducing damage to the fascia.
In essence, 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 of you with this condition, the same principles apply. You may not need to perform at the activity level of a world class athlete, but getting rid of the pain just to simply return to work comfortably should be all the motivation you need to do something about it.
Until next time,
Scott R. Kilberg DPM
Serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville indiana
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