USA Today / Dr. Raj

Plantar fasciitis knocking top athletes off their feet

August 27, 2013

Plantar fasciitis knocking top athletes off their feet


ANAHEIM, Calif. — For most of this baseball season, playing a game seemed like the furthest thing from Albert Pujols’ mind when he woke up in the morning.

The most pressing issue was how to stand on his feet and get to the bathroom.

“You almost want to pee in your bed rather than go to the bathroom,” Pujols tells USA TODAY Sports. “It’s really painful in the morning.”

The pain came from Pujols’ plantar fascia, the thick connective tissue that supports the arch of the foot from the heel toward the bones in the mid foot. When that tissue is inflamed due to overuse or small tears in the fascia, the result is the agonizingly painful condition called plantar fasciitis, which is a four-letter word to a seemingly growing number of athletes who have suffered from it in recent years.

This list includes Pujols, Tampa Bay Rays third baseman Evan Longoria, San Diego Chargers tight end Antonio Gates and NBA stars Pau Gasol of the Los Angeles Lakers and Joakim Noah of the Chicago Bulls.

Noah played through the condition in the playoffs but issued a comment that had anyone who has ever endured plantar fasciitis nodding knowingly.

“Plantar fasciitis sucks,” Noah said. “It feels like you have needles underneath your feet while you’re playing.”

Pujols is currently the most prominent plantar fasciitis victim, with the Los Angeles Angels announcing Monday that the 33-year-old, $240-million first baseman/designated hitter will sit out the rest of the season so that his foot might heal and give him a chance to report healthy to spring training next year.

Pujols played in pain all season, mostly just as a DH. He says his plantar fasciitis, too painful for him to play first base regularly, didn’t affect his performance at the plate. But his numbers were the worst of his career — .258, 17 homers and 64 RBI.

“There’s no doubt when you don’t have that good solid base, if affects you,” says Angels manager Mike Scioscia.

Pujols and the Angels have decided that extended rest is the answer, but there is no guarantee Pujols will be pain-free next spring. Plantar fasciitis can linger. It is one of the most difficult athletic injuries to heal, partly because there is so little blood flow around the heel and also because any sort of running or jumping continues to offset the various treatment options, primarily physical therapies and anti-inflammatory medicines. Even after extended rest, recurrence is common.


Surgery is considered a last option and certainly not a desired one, as the recovery can be lengthy, up to a year.

“I’ve been dealing with this for nine years,” Pujols says. “This was the worst of all the years. Hopefully, with rest, it will be fine.”

While there is a lack of data showing that the condition is showing up more frequently in professional sports, there is a lot of talk among athletes and the orthopedic medical community that there is more plantar fasciitis than there used to be among both pro athletes and so-called weekend warriors.

“You do hear about it more and more,” says Los Angeles Dodgers manager Don Mattingly, whose star pitcher, Clayton Kershaw, persevered through a plantar fasciitis condition in 2012. “When I was playing, I never really heard about it.”

Robert Klapper, chief of orthopedic surgery at Cedars-Sinai Medical Group in Los Angeles and host of a radio show about sports injuries, has a couple of theories about what he tells USA TODAY Sports is an “explosion of overuse injuries like plantar fasciitis.”

Klapper says he thinks that sports specialization at a young age is leading to a lack of natural cross training and to a greater number of injuries caused by repetitive movements.

In earlier generations, a young three-sport star — say, football, basketball, baseball — was common. Now, young athletes who stand out in a sport tend to play it year-round on all-star or travel teams. And there is a lot more time spent inside on computers or watching TV. Now, the two-sport star — say, basketball and video games — is more common.

“Cross training is so valuable, and it used to come quite naturally,” Klapper says. “We’ve lost that.”


Dodgers athletic trainer Sue Falsone agrees.

“We are just starting to see those kids who have been told to specialize at age 10 come to the surface right now,” Falsone says. “I don’t think we quite know yet what that does.”

Klapper says that some athletes do not do enough stretching. Calf stretching, in particular, is essential in warding off injuries such as plantar fasciitis and a closely related condition, Achilles tendinitis.

Also, he suggests that athletes who have symptoms of plantar fasciitis need to wear stiffer-soled shoes.

Bal Rajagopalan, a Beverly Hills, Calif., orthopedic surgeon, agrees that proper shoes can help athletes avoid chronic plantar fasciitis.

“Naturally flat-footed people are more prone to plantar fasciitis,” he says. “They should be wearing sneakers with high arches. Sometimes you see athletes wearing these minimalist shoes with little or no cushioning. That’s horrendous. They are bound to have problems.”

Pujols says he is flat-footed but says experimenting with different shoes hasn’t been the answer.

“I’ve been with Nike my whole career, and they always work with me to try to make it comfortable,” Pujols says. “But I don’t think the shoe has anything to do with it.”

Former Angels outfielder Tim Salmon struggled with plantar fasciitis in the middle of his career, eventually having surgery on both feet. He says the battle with plantar is mental as well as physical.

“It’s like having a sore tooth all the time,” says Salmon, now an Angels broadcaster. “You can’t quite focus 100% when you have a sore tooth. It’s always throbbing. It just takes away from your focus of getting ready. My mental preparation of getting ready for a game was diminished over time because I was spending more time trying to get myself healthy and ready to play that night.”

Gates, the Chargers’ perennial Pro Bowl tight end, hobbled through subpar years in 2010 and ’11 because of a chronic case of plantar fasciitis.

“When I first had it, it wasn’t that common,” Gates says. “I’m hearing about it more and more.”

Like Pujols, he knows the fear of the first step out of bed in the morning.

“You’re literally standing there 15-20 minutes, knowing that first step is going be to like an ice pick sticking in your foot,” Gates says.

Gates missed six games in 2010 and three more in ’11. “I just couldn’t play sometimes,” he says. “And sometimes, the only way I could play was to take injections (of painkillers). I contemplated retiring. I didn’t think I could keep going like that.”

Gates, 33, a former Kent State basketball star, says he lost weight and played a lot of basketball before last season and the pain subsided a great deal. Now, he hopes he’s put plantar fasciitis behind him.

“It gets sore at times, but it’s nowhere near where it was,” he says.

Maybe the Angels, who will enter 2014 owing Pujols $212 million over the next eight seasons, should sign him up in a rec basketball league.

Original Article

Dr. Raj

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