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Plantar fasciitis -- the most maddening injury in sports

He limped into town, an optimistic grin plastered across his face, a harsh reality damning his body. Because Scott Podsednik is a ballplayer, and because ballplayers believe they can -- and will -- overcome all obstacles, the veteran outfielder optimistically addressed the media on a warm February day three months ago. "The foot's getting better," he said, standing before seven or eight reporters at the Toronto Blue Jays' spring training facility in Dunedin, Fla. "I should be back and ready to go full speed in a couple of days."

As if to prove his point, Podsednik bounced up and down, a little jig to show that, hey, he'd quickly return to his life as an arm-pumping, leg-churning stolen base machine. In 2010 Podsednik, playing for the Royals and Dodgers, stole 35 bases. In 2004 -- not all that long ago -- he led the majors with 70 swipes. With just a little more time ...

"I expect to definitely be ready for Opening Day," Podsednik said. "This is just a speed bump. I'll be ready ..."

Opening day came.

Opening day went.

The month of April came.

The month of April went.

It is now early May and Scott Podsednik is a member of the Las Vegas 51s, Toronto's Triple A team in the Pacific Coast League. He has yet to take a Major League at-bat, yet to test himself against the best of the best, yet to regain the form of a ballplayer who once helped the Chicago White Sox win the World Series in 2005.

All because of plantar fasciitis.

*****

The diagnosis has been around since the 1970s when, team physicians and trainers have tried explaining to players that the inexplicable, oft-unbearable pain tearing through their feet was an inflammatory process of the plantar fascia.

Or, in simpler terms: All homo Sapiens have a thick fibrous band of tissue that begins on the heel bone and extends along the sole of the foot toward the toes. When this band, aka the plantar fascia, becomes inflamed, it hurts. "Sort of the same as someone picking up my foot, grabbing a thick piece of wood and slamming it repeatedly into my sole," says Morgan Valley, a former guard for the UConn women's basketball team whose battles with plantar caused her to miss 23 games of the Huskies' undefeated 2001-02 season. "It's a uniquely terrible injury."

According to a 2003 article in the Journal of Bone and Joint Surgery, two million Americans are affected by plantar fasciitis every year, and 10 percent of the population will experience the injury within their lifetimes. Yet while plumbers and lawyers, chefs and musicians surely find plantar-caused discomfort to be uncomfortable, for an athlete it is often akin to the worst imaginable nightmare. "I've been told that the most important way to heal is by resting and staying off your feat and away from impact," says Valley, now an assistant coach at the University of Massachusetts. "Well, what athlete has time to do that? Athletes are all about impact."

Indeed, that's where the terror of plantar fasciitis begins -- with the competitor, and with the need to stay on the court/field/track and fight through and overcome. Through the decades, plantar has taken down some of sports' biggest names -- from Tim Duncan and Kobe Bryant to Pete Sampras. There is, apparently, no rhyme or reason. Some people get it. Some people don't. Some people recover quickly. Some people don't.

Generally, the pattern goes like this:

Stage 1: Athlete is diagnosed with plantar.

Stage 2: Athlete insists he'll return in a couple of days.

Stage 3: A couple of days pass.

Stage 4: Athlete plays for the first time, oh, a week after diagnosis, and the pain is worse than ever.

Stage 5: Several weeks pass.

Stage 6: Several more weeks pass.

Stage 7: The foot begins to feel better. The athlete attends a first practice and re-aggravates the injury. He ices. He warms. He stretches. He is fitted for insoles.

Stage 8: Athlete makes a highly publicized comeback, steps awkwardly and finds himself back in the trainer's room.

"It's the worst," says Chris Burgess. "The absolute worst."

If anyone knows about the debilitating aspect of plantar fasciitis it's Burgess, the former Duke and University of Utah center who has spent the past decade playing basketball around the world (he spent last season with Zastal Zielona Góra in Poland). Ten years ago, during his senior season at Utah, Burgess felt a peculiar pain shoot through the bottom of his left foot during a practice. When the Utes' trainer, told him he appeared to have plantar fasciitis, Burgess did a double take. Plantar what?

"One of the things that makes plantar fasciitis unique is that nobody really seems to get it," Burgess says. "I had a teammate at Utah, Mike Puzey, and my junior year he had plantar and missed a ton of time. He'd be getting an ultrasound on his foot and we'd all be making fun of him. It was like, 'You're missing time because of a little foot pain? Really?' I had no idea."

Burgess quickly learned his lesson. He was told to treat the malady by sleeping with a sock that kept his foot and heel straight at night -- and he did so, while continuing to play.

On December 29, 2001, in a game against Texas in Salt Lake City, Burgess was posting up when he tried to spin for a rebound. "I felt a zipper rip from my heel to my toe," he says. "I've broken bones, I've had some bad things happen to me -- but never pain like this."

Burgess had actually torn the fasciitis muscle. He sat out most of the following month, and during that time tried seemingly every possible remedy. He wore special lifts in his shoes, iced regularly, rested. By the time he returned to practice, Burgess and the Utes were cautiously optimistic -- "I thought, 'I'm back!'" he says. "Then, two days after that first practice, I couldn't walk. It was as bad as ever."

Burgess missed the remainder of the season, including the NCAA tournament. Gradually, with time and help from a stretching board, the plantar faded. The memory, however, hasn't.

"All these years later, I still hate thinking about my time with plantar," he says. "It was a bad dream."

*****

William McGarvey has a patient. He won't name names or give many specifics. But the person, he assures you, exists. "My patient has been suffering with plantar fasciitis for five years," he says. "It won't go away."

McGarvey, an associate professor of orthopedic surgery at the University of Texas, has tried his all. "The patient had surgery," he says. "He had injections. But it hasn't gone away. I'm now wondering if the patient even has plantar fasciitis, because I've never seen anyone have it forever. But I guess it's possible ..."

Like many in his field, McGarvey considers plantar fasciitis to be the greasy pig of foot injuries -- visible and even manageable, but insanely hard to grasp. It is an equal-opportunity injury -- from offensive linemen to sprinters to goalies to point guards, all are at risk. "There's a misperception that someone with plantar needs more cushioning," he says. "Not true. What he needs is assistance with the arch. The problem is the arch collapsing, so the foot needs structure and firm support."

Here, in a nutshell, is the great enigma with plantar. What McGarvey says is right -- but sort of not always right. It all depends ... on something. "It seems like hocus-pocus to people," says Kate Whitney, the director of physical therapy at Anderson Orthopedic Clinic in Washington, D.C. "People use stretching to fix it, people use laser surgery. It can be very enigmatic."

Indeed. Stacie Alboucrek, one of the country's top women marathoners, developed plantar from doing landscaping work around her house, then aggravated it by working out on a treadmill. Some podiatrists, however, urge sufferers to try running on treadmills instead of the open road.

Kopal Goonetileke, a Westchester, N.Y.-based franchise owner of Baby Boot Camp, which offers fitness classes for new mothers, was initially advised to have a handful of cortisone injections. Many experts, however, say the injections should only be a last resort.

"Fortunately I was nursing at the time, so I couldn't do it," says Goonetileke, who recalls a pain so excruciating that she was unable to walk barefoot. "Then I bought these sandals with a raised arch and the pain pretty much went away."

When the Spurs' Duncan first dealt with plantar in 2005, many in the sports media pooh-poohed the injury, equating it to a sprained toe. He was fitted for special orthotics, which, over time, worked -- but don't always work. Nicole Kaczmarski, a former guard at UCLA, missed three of her college seasons struggling with plantar. Upon signing as a free agent with the New York Liberty, she was encouraged to spend more time soaking her left foot in a whirlpool. Most doctors would scoff at such an idea.

Drew Gooden signed as a free agent with the Milwaukee Bucks before the 2010-11 NBA season and was thought to be a key component on a rising team. The plantar in his left foot was so debilitating, however, that the team shut him down in January. Gooden was sent to Los Angeles, where Richard Frekel, an orthopedic surgeon, treated him with three shockwave therapy sessions. Gooden returned a new man, averaging 11.3 points and 6.8 rebounds in 35 games. For others, though, shockwave therapy has little impact.

Of late, there's been increased debate whether plantar fasciitis should even been known as plantar fasciitis. In 2003, a Temple University podiatrist named Harvey Lemont studied the tissue samples from 50 patients apparently suffering from plantar fasciitis. All of the people were undergoing heel-spur surgery, which seemed as sensible as any of the other treatments. Yet when he examined the patients, Lemont said none showed any signs of inflammation. "In fact," he wrote, "the suffix '-itis' inherently implies an inflammatory disease."

Lemont concluded that modern athletic shoes tend to pull toes upward, resulting in a stress on the muscles that impedes blood flow to the plantar region. "So the junk never gets flushed out," Ray McClanahan, a Portland, Oregon-based podiatrist, told Running Times magazine. "[What we need to focus on] is putting the toe back where nature meant it to be."

Are Lemont and McClanahan right?

Are they wrong?

Will Scott Podsednik, now batting. .254 for the Las Vegas 51s, ever return to form?

In the mysterious would of plantar fasciitis, the answer is, appropriately, a question.

Who the hell knows?

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