Washington Mystics guard Kristi Toliver is out for at least two weeks due to plantar fasciitis. We recently spoke to Dr. Damian Roussel of The Centers for Advanced Orthopaedics. Dr. Roussel is a podiatrist and much of his practice focuses on athletes. His practice is based in Frederick, Md., about a one-hour drive northwest of Washington.
As a disclaimer, Dr. Roussel's answers should be considered general trends among people in a similar situation as Toliver’s, and are not to be taken as medical advice. The information below also does not indicate what Toliver herself has experienced or is experiencing. Please consult your specific doctor for your specific situation.
And now the Q&A. Some of the text was edited for clarity.
Bullets Forever: Dr. Roussel, what is the plantar fascia in the foot and what purpose does it serve? Then what injuries can people have there?
Dr. Roussel: The plantar fascia is a broad ligament on the bottom of the foot that connects the ball of the, uh, and it supports the bottom of the foot and the arch.
People can have acute injuries like plantar fascia tears. Plantar fasciitis is an inflammation of the plantar fascia which can become a chronic condition. That can cause pain and swelling which it makes it difficult to walk. It will certainly be more difficult with higher-impact activities like running and jumping.
BF: For example, running with improper shoes can cause plantar fasciitis. Not saying that Toliver is wearing improper shoes, but could that lead to this condition?
Dr. Roussel: Yes, wearing improper or unsupportive shoes can lead to plantar fasciitis. Wearing unsupportive shoes can also lead to tightness in the calf muscle.
But given that Toliver is a professional athlete, she probably won’t be tight while playing or practicing. She’s active and will have stretched plenty. And professional athletes like Toliver generally wear proper footwear. So she could have suffered the injury by coming down hard on the foot, which overstretched the plantar fascia. And if she continues to play, her plantar fascia can be further aggravated.
BF: From what you are saying, does plantar fasciitis happen over repeated stretches in someone like a basketball player?
Dr. Roussel: It can be acute from one particular step, but most of the time, it’s a cumulative process such as overuse of the foot.
I think athletes are more likely to start having symptoms outside of basketball, like when they’re just walking and doing regular activities. Sometimes, basketball players wear unsupportive shoes when doing errands or hanging out downtown.
And many players are also flatfooted. If they’re flatfooted and they’re doing activities outside of basketball, that’s not supportive as far as the shoe gear, they can get the symptoms of plantar fasciitis. Then basketball activities can aggravate them.
In Toliver’s case, I’d be interested to know how long the symptoms have been there. People who have plantar fasciitis are more likely to continue to have it or have sort of recurrent bouts with it.
I don’t know how long she’s had the symptoms or if she has pain with normal walking. If so, it would make sense that she would’ve even more pain with higher-impact activities like running and jumping.
BF: What is the timetable for recovering from plantar fasciitis? The news release on June 20 stated that she would be out for at least two weeks.
Dr. Roussel: I don’t see athletes getting plantar fasciitis resolved in two weeks. It’s usually a longer process than that. The longer they’ve had the condition, the longer it takes for it to go away.
That said, I would say that two weeks is a reasonable timetable for someone to resume normal activities again, such as walking. But for athletes, it takes about a month for them to be able to resume high-impact activity. Athletes must ensure their plantar fascia are better healed than the average person.
BF: What are the typical treatments for someone with plantar fasciitis?
Dr. Roussel: I ask the patient if they can walk without a limp. If they’re not able to walk comfortably without a limp doing regular activities, I’ll immobilize them in a boot like a cam walker or immobilization boot just to let it quiet down and decrease the stress on the fascia until they’re able to walk comfortably in a supportive sneaker.
And then when they can do that, I make sure that they don’t go barefoot and walk with a sneaker with proper arch support. Or, for athletes who sometimes do a taping, we’ll do an arch taping or a low-dye taping that helps support the plantar fascia directly on the skin. And I have them do that with a supportive shoe and activity restrictions, no running and jumping, trying to get them comfortable for just regular walking.
I have them stretch the plantar fascia and the calf muscle independently or with a trainer. Sometimes they will take anti, non-steroidal anti-inflammatories like medication like Motrin or topical anti-inflammatories. If the athlete has access to a trainer or a therapist, they can do some physical medicine modalities like electrical stem, ultrasound, massage and ice. That also helps to decrease pain and inflammation.
BF: Finally, regarding plantar fascia injuries like plantar fasciitis, what can we all do to minimize the chances of these happening?
Dr. Roussel: If you start having pain, the first thing you should do is avoid, and remove any aggravating factors like running and jumping. If it hurts to walk, then you shouldn’t do any high-impact activities like running and jumping. Avoid uneven ground, like hills and inclines.
Long term, the best chance of it not coming back, or if it does come back for it to be not as severe, is to do two things. One is to increase support on the foot, so make sure you’re wearing a supportive shoe and not doing much activity barefoot or wearing unsupportive shoes.
And then the second thing is stretch. Keep the calf muscle, and the plantar fascia stretched out. So do stretches where you pull your toes towards your nose to keep all the posterior muscles stretched out, like the calf and hamstring. But long term, lowering the risk has maximized the support in the shoe and decreased the tightness and the stress on the plantar fascia.
Thank you to Dr. Roussel for his input. We will have more interviews with the physicians from The Centers for Advanced Orthopaedics when players unfortunately get injured.