October 4, 2020, 7:04 am
The Lakers currently hold a 2-0 series lead over the Heat in what has thus far, been a somewhat one-sided NBA Finals. With no games played on Saturday and very little in the way of NBA related news, I went a little off-track for today’s edition of the dish. Game 1 resulted in a blow out victory for the Lakers, as well as a pair of devastating injuries for the Heat. While there is some optimism that Bam Adebayo will be able to play in Game 3 on Sunday, the same cannot be said for Goran Dragic. The veteran point guard was putting together his best stretch of basketball in more than three years when he suffered a torn plantar fascia in his left foot during the second quarter of Game 1.
That is where we pick things up for Saturday’s Daily Dish. I am by no means an expert on the workings of the foot, in particular, the plantar fascia and the purpose it serves. To dive further into the specifics of the injury and the potential outlook, I called on one of my friends to gain his professional perspective on the current situation. Sam Abdelmalek is a Sports Podiatrist and Mechanical Design Engineer based in Melbourne, Australia. Having worked with Sam in a previous life, I knew he would be the man to talk to if I was to gain a better understanding of the plantar fascia.
What Is This ‘Plantar Fascia’?
Where is the plantar fascia (pf) located exactly?
The pf is a fibrous band that connects the heel to the ball of the foot. It is typically described as a fan-like structure since it has three bands that all originate at the heel, and then ‘fan out’ to the ball of the foot. The three bands are the medial, or inside band, the middle and lateral, or outside band.
What purpose does the pf serve?
Being a taut structure that runs on the underside of the foot, the main job of the pf is to support and reinforce the arch, which is under extreme tension every time you land on your feet. When you run and jump, that is 3-4 times your body weight is trying to push your arch down and cause it to splay. Without a taught structure such as the pf, our feet would just collapse. But more than that, it also serves a very important biomechanical function, in that it helps the foot become a rigid lever that you can push off on when you take a step forward. In this way, it helps us transfer our weight from our landing position to our
propulsion position, to powerfully propel us forward with each step.
Depending on a partial or complete tear, what are the potential treatment options?
When you put that much strain through the pf, and since it doesn’t like to be stretched – being a fibrous structure, it will eventually start to develop what we call microtears, which the body has to try to heal. The presence of these microtears, and the inflammation that ensues as the body goes to work to heal them, is what we commonly refer to as plantar fasciitis. Sometimes, as these microtears get bigger (think of a rope that is starting to fray), and the structure becomes weaker, an increase in loading can cause these tears to become larger.
A partial tear is simply a tear that is big enough to weaken the structure, but one that doesn’t extend to the full thickness of the pf – which would be a complete tear, or rupture. There is a whole range of treatments for these partial tears, depending on whether they run along the length of the fascia (longitudinal), or across the width (transverse), or if they are within the fascia or on the edges, etc.
In any case, the first option is always to reduce the load on the fascia, so that the body can heal, and to prevent the small tears from becoming larger. We can do that with things like moon boots, orthotics, and strapping. Then there are options to improve the healing capacity of the body, that are used with these load-reducing strategies, like Platelet Rich Plasma injections (PRP) and hyperbaric oxygen therapy.
With complete tears, the only treatment is surgery, but this is generally put off since the pain that we experience with loading a partially torn fascia is avoided in the case of a complete tear.
What is the typical recovery time for such an injury?
You can absolutely battle through a partial tear, with the strategies mentioned above, but that is purely dictated by symptoms and whether the athlete can perform to an acceptable standard. This will ultimately come down to the extent and classification of the tear itself and the athletic demands of the position the athlete plays in – ie. How much loading it will be subjected to. Typically, even though the injury can be played through, for healing, we would be looking at anywhere between 6 and 12 weeks – of course depending on the rehab strategies and loading differences from case to case.
Some athletes get around this by turning a partial tear into a complete tear via surgically cutting the fascia, or forcefully loading the fascia repeatedly and essentially snapping it themselves. Think Robert Harvey from St Kilda (Aussie Rules Football), or Josh Kennedy from West Coast (Aussie Rules Football). This is excruciating at the time, but does get rid of the pain since there isn’t any more forceful stretching! The functional ramifications are a different story, but they do get back to playing a lot quicker!