Expert Health Articles

What's Wrong with Peyton Manning's Foot?

Dr. Thomas F. VailDr. Thomas F. Vail

Step Alive Foot & Ankle Center

The NFL playoffs this year saw some injury-depleted teams getting their key players back. If you’re a Denver Broncos fan, then the return of Peyton Manning, the star quarterback for the Denver Broncos, back under center was an exciting turn in week 12 against the Pittsburgh Steelers. As many seasoned NFL fans know the risk for injury increases as many of these athletes are tired and fatigued from an entire season of brutal contact and physicality. Peyton Manning was one of the most notable injuries that occurred this season. He suffered from plantar fasciitis for several weeks, but aggravated the injury against Indianapolis on Nov. 8, resulting in a partial tear of his plantar fascia. Almost always, a partial tear is more painful to play with than a complete tear.

Many spectators wondered why Peyton was unable to play when he appeared from the sideline completely uninjured and healthy. A person can have plantar fasciitis and then have a sudden increase in force through the plantar fascia, like a sudden push-off that can cause a tear. Sometimes things are done that can weaken the plantar fascia that can cause a tear. Chronic plantar fasciitis is treated with cortisone injections and although that decreases the pain sometimes, it also causes weakening to the fascia and that can then result in a tear if enough force is put on it.

Plantar fasciitis typically presents at the bottom of our feet where our skin is very thick and tough due to the constant barrage of body weight applied. This stress creates a natural callus on the bottom of our foot, which builds up and becomes very tough over time. Underneath this thick calloused skin is the plantar fascia. The plantar fascia is a thick band of tissue that connects the heel to the base of the toes.  The plantar fascia band serves as an arch support and shock absorber. Plantar fasciitis results when an individual experiences inflammation of this area of the heel. Many describe the pain as a burning sensation in the heel or the feeling of constantly walking on glass. Pain is more intense after first getting out of bed in morning.

The treatment for plantar fasciitis often takes six to eight weeks, during which time the patient is typically in a lot of pain. If it is not given the proper time to heal then the risk of a tear is increased. A tear can be partial or full as was the case with Peyton’s brother Eli, who suffered a full tear of his plantar fascia in week four of the 2009 season. 

The first line of treatment for plantar fasciitis is conservative measures including RICE (rest, ice, compression, elevate), stretching, and possible NSAIDS or corticosteroids injections. To the average spectator, it might have seemed like Peyton was abusing his “sick leave,” but the reality is that his course of treatment actually fell perfectly in line with the clinical standards and timeline.

Although Peyton was able to play part of the game during the Broncos win over the San Diego Chargers, his recurrence of the plantar fasciitis and subsequent partial tear were inevitable due to the high activity and physical nature of the sport. In other words, doing too much, too fast will damage Mother Nature’s repair job.

A plantar fascia partial tear is not generally considered a surgically repairable injury because it usually heals well on its own and the surgical access might have more risk of scarring than the potential for improvement. The treatment is non-operative and healing the tissue back to full strength takes 12 or more weeks. The usual treatment is to control the pain, put the arch and foot at rest to allow the tissue to reconstruct, and as the symptoms begin to settle over a week or two, begin gentle stretching and limited, protected walking. Normal standing or walking may be possible in a few weeks. The return to high level running may require several months.

Platelet-rich plasma (PRP) injections can speed the healing and improve outcomes and have been proven successful for athletes.

Maybe with this information in hand you’ll know the signs of plantar fasciitis and visit your foot doctor at the first sign of pain. At the very least it could help your future fantasy football team!