Last weekend, in what looked like a pretty mundane play, New York Giants quarterback, Eli Manningsuffered an injury to the bottom of his right foot. It was enough to sideline him for the rest of the game and to keep him out of practice on Wednesday, according to the injury report at NFL.com.
Plantar Fasciitis is inflammation of the plantar fascia, a dense connective tissue structure that runs along the bottom of the foot from the heel to the area around the ball of the foot.
Though referred to as one unit, it is actually comprised of many thin layers that have to work together and glide over each other in order for it to work together as one unit. When that area gets inflamed, the layers do not properly glide and as a result cause pain in the bottom of the foot.
The severity ranges, a relatively mild case can be isolated to one area of the foot, where a severe case can be felt from the heel to the ball of the foot.
Based on reports, it seems that the injury is located on just one area of the foot. Nevertheless, plantar fasciitis can be unbelievably painful, it effects nearly 2 million Americans each year and may affect 10 percent of the American population in their lifetime.
It is a condition that has sidelined Tim Duncan of the San Antonio Spurs and Shaquille O’Neil of the Cleveland Cavaliers. The patient’s that I see with this diagnosis report that basic tasks, like walking, are unbelievably painful let alone high performance task like throwing a football.
The foot is foundation of the body and, as a result it is the foundation for proper biomechanics of the football throw. The injury is located in Manning’s right foot, which he uses to the plant before he passes the football.
The condition could affect his ability to plant and drive off of his right foot, which could affect his accuracy; it could increase time the ball is in the air, and give the defense more time to react.
Additionally, it can affect his ability to generate power on down field throws and will limit he mobility in the pocket in attempts to avoid the defensive pass rush. Typically the goal of treatment is to decrease the initial inflammation associated with acute injuries by resting and icing the structure.
Going forward, the goal needs to be to continue to address the residual inflammation in the area as well as improve the range of motion. Electric stimulation, ultrasound, iontophoresis or phonophoresis with 0.4 percent dexamethasone are indicated along with use of cold laser and stretching the gastrocnemius and soleus, which make up the “calf muscle.”
On game day, the medical staff can use injection therapy and give extra support to the area with taping techniques. Additionally they can modify Manning’s footwear to decrease the symptoms in an attempt to decrease the effect of the injury on his performance.
In Manning’s situation, because he is a professional athlete, other biomechanical factors such as tightness and strength deficits of the hip and knee may not need to be addressed.
However, if you have or are experiencing these symptoms, be wary of a treatment program that is isolated to the bottom of the foot. In most situations, plantar fasciitis is caused and is, therefore a symptom of biomechanical issues elsewhere in the body.
These muscle imbalances cause the plantar fascia to be overloaded with forces it is not able to withstand causing injury. Addressing just the plantar fascia and without addressing additional factors increase the chances of the recurrence and could make the situation chronic.
Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of Health Sciences at Duquesne University in Pittsburgh, PA. He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various sports medicine clinics around the country. Currently, he is the managing partner at Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, NC.