The roller coaster ride that is the Lakers' 2012-13 Season hit another bump on February 5, when star center and power forward Pau Gasol tore the fascia in his right foot. Although we commonly hear of the chronic injury plantar fasciitis, a torn plantar fascia is rare.
Given Gasol's return timetable of six to eight weeks, the Lakers will certainly miss their big man and his game averages of 13.4 points and 8 rebounds. But how the team regroups is not as interesting as Gasol's recovery, since his main job is to run and jump, actions that place direct stress on the plantar fascia tissue.
A strong layer of white fibrous tissue, the plantar fascia begins in the heel, stretches along the length of the foot and eventually divides into five sections on the underside of the toes. Its main functions are arch stability and assisting the first toe in upholding body weight. Your big toe actually supports a great deal of your weight when you run or walk, because it's the last part of the foot to push off. When a plantar fascia is torn or injured, the majority of weight is transferred onto the second toe, causing a painful callus or even a bone spur.
When a condition ends with the suffix "itis," it involves inflammation and symptoms like pain, swelling and stiffness. A tear means damage has occurred to the tissue and the symptoms are more severe. Generally, those suffering from plantar fasciitis have intense pain early in the morning, after the foot has remained still and stiffened up overnight. Most of this discomfort is along the inside front portion of the heel, where the fascia attaches. Because of the tissue's length, an ache can be felt throughout the entire arch of the foot. Usually movement will reduce pain, but too much can cause it to worsen. The opposite is true with a tear; motion will actually increase discomfort.
The main difference between fascia pain and other foot injuries is the ability to raise the toes, which causes the fascia to tighten. If lifting your toes causes notably worse pain in the plantar surface of the foot, you're probably suffering from a plantar fascia issue and need an MRI to determine the extent of the damage.
The basic prescription for all plantar fasciitis patients is to stretch the Achilles tendon, the muscle that attaches to the calf. Several studies have shown this to be an effective treatment, because it alleviates pain by removing tension from over the midfoot. In severe cases like Gasol's, casting is necessary to completely remove stress from the tissue and keep the Achilles tendon in stretch position. A more conservative alternative is to wear a night splint, which keeps a stretch on the foot during sleep, thereby alleviating early morning pain. In a study by Powell, 88 percent of patients improved by using this therapy. Medications and injections are also frequently prescribed for treating damaged tissues and reducing inflammation.
Because the plantar fascia is located in the arch, often a shoe orthotic will be prescribed. However, it's extremely important to be correctly fitted with the proper type. Another study by Powell showed that 75 percent of patients with plantar fasciitis in a normal foot still used an orthotic for a pronated foot type. For those with a normal foot type, a "Thomas Heel," an orthotic with a tilted wedge, helps control the pressure around the heel to relieve stress to the tissue more efficiently.
For chronic sufferers of plantar fasciitis, soft tissue work is needed to improve tissue quality, decrease localized pain and eliminate localized waste products caused by inflammation. Once the tissue is healed, therapeutic activities are the athlete's next step to return to play.
Once an athlete has been cleared to begin this stage, he or she needs to focus on two main recovery areas, maintaining ankle mobility and increasing stability.
Ankle mobility is important for change of direction movements, deceleration and landing, as well as for proper squat technique. Mobility is gained through mobility drills (like these mobility drills) to maximize active range of motion in the joint.
Since stability contributes to strengthening joint muscles, stability exercises should go hand in hand with your injury recovery program. For any ankle and foot problem, you need to strengthen in all planes of movement. The best way to improve stability is to perform strengthening activities barefooted.
Barefoot Heel Walks and Toe Walks
Perform these forward, backward, sideways and with carioca. Gradually increase the pace, but not to the level of plyometrics, especially if you're on a hard surface.
Barefoot Kettlebell Swing
This is a great endurance, mobility and strengthening exercise rolled into one. When performed in bare feet, it strengthens the small stabilizer muscles in the feet. The weight of the bell promotes strength gains, and performing higher reps trains the muscles to work while fatigued. (Read The Advantages of Kettlebell Training.)
Dragging a Sled
Since the plantar fascia is stressed through all planes of movement, it's important to train and strengthen the ankle in multiple planes. All exercises can and should be performed with varying speeds and amounts of resistance.