Dime Q&A: Expert Surgeon On Tyreke Evans & Plantar Fasciitis

For being a real menace, foot problems always get overlooked. If someone has knee surgery, it’s okay if they come back a little slow. They’re working themselves back into shape. If someone has a wrecked and twisted back, bash the maker for giving them back luck. We rarely hear anyone talk about feet outside of the mammoth one-timers like Yao Ming or Bill Walton. No one was supposed to ever get that big. Broken feet are only a byproduct. That’s the perception.

But smaller players can have their base taken out from under them too. Tyreke Evans‘ second NBA season was basically destroyed by plantar fasciitis.

Since ‘Reke went from having one of the best rookie years in NBA history to being cast as nothing more than a decent player – all in the span of one season – I had to question: how much did the injury play into his sophomore slump? So I caught up with Dr. Bal Raj, who was named “One of the Leading Physicians on the World” by the International Association of Orthopedic Surgeons (American & Canadian) and has tons of experience with athletes.

This is the third and final excerpt from an interview where we talked Kobe Bryant and his mysterious surgery, Gilbert Arenas and chronic knee issues and now Tyreke…

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Dime: Tyreke Evans dealt with plantar fasciitis all of last year. Could you talk and explain to us exactly what that is.
Dr. Bal Raj: Yeah. Plantar fasciitis is basically inflammation where the plantar fascia, meaning it’s the facsia underneath your foot below your flexors that connects from your toes to your heal area. So what happens is when this fascia gets inflamed, it gets inflamed near the heel area and it’s usually caused by number one, someone who is normally flat-footed because they have their plantar fascia on a constant stretch, and don’t have the normal arch. And number two on impact, for someone who jumps up and down like a basketball player. In general, the negative injuries have insertion at the heel. Your classic symptoms are pain when you get up and stiffness when you get up because what happens is all night when it’s inflamed, your foot actually flexes down and gets contracted. So when it actually gets contracted, the first step you take it the most painful step. Then, you start working it out.

It also usually happens in people who are overweight. So someone who has excessive weight and also a lack of a normal arch will be more prone to plantar fasciitis.

Dime: Is the injury unpredictable for athletes because it seems like it comes and goes with guys?

DBR: It is unpredictable. It’s set up in certain people. Certain people may innately have a solid arch and strong flexors so therefore they won’t load their plantar fascia as much. So in general, it is unpredictable who gets it, but at the end of the day the people you see who get it are usually people with normally a flat foot without a normal arch, number one, and number two, people who are excessively overweight who do a lot of jumping.

Dime: You mentioned the flat arch. Once you have the issue with plantar fasciitis, does it ever really go away or will you be dealing with it for the rest of your career?
DBR: The basic aspect of it is there are ways we can treat it, and even a surgical option is not the best. That’s actually not good at all. So surgical options, injections, and then there are products and arches which people can put in their shoes.

But the reality is if you are prone to plantar fasciitis, the likelihood is that you are going to get it on a recurrent basis. All you can really do is be preventive. A few preventative things that work aggressively with a trainer or physical therapist to stretch out your plantar fascia and strengthen your flexor tendons in your foot to kinda unload your plantar fascia, number one. Number two, when you sleep at night, wear a product that will actually keep your plantar fascia stretched so you won’t contract and be so inflamed in the morning. If you’re compliant with a program and a trainer, you will mitigate your frequency of getting plantar fasciitis.

Dime: If you play on it, will it develop into something worse? Obviously, it will hurt, but can it get any worse?
DBR: No, not usually. In general, what will happen is you will just create an alter blood supply where the plantar fascia attaches onto the heel, which is called the calcaneus. It will create a cycle of tendinosis. That’s number one. Number two, this is so painful that once you’re on it, it’s not the type of injury that you keep on playing on. You actually stop because it’s that painful, and you get treated.

So it’s not like a mild low-grade ankle sprain where if you just keep on jumping, you’re gonna fracture your ankle. This is like, once it’s active, you don’t wanna play. You wanna get this treated.

Dime: Over time as you get older, are there any long-lasting effects to it?
DBR: Yeah, long-lasting effects, obviously, the setup that causes this in most instances is weight and number two, a flat foot. In general, you’re gonna start overloading your smaller joints within your foot. So you will be more prone to arthritis in your foot, as well as your ankle.

What do you think?

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