USA TODAY - What's wrong with Peyton Manning according to MMI foot & ankle expert

Writen by Nina Mandell of USA TODAY

Peyton Manning reportedly played on Sunday with a partially torn plantar fascia — an injury that has reportedly made it difficult to walk in recent days. One expert told USA TODAY Sports that it’s an injury that he can play through — as long as he can manage the pain. For more on the injury, we went to Dr. Damian Roussel, orthopedic surgeon with The Centers for Advanced Orthopaedics – Mid-Maryland Musculoskeletal Institute Division.

WHAT IS PLANTAR FASCIITIS?

Plantar fasciitis in its chronic state, people can get chronic or acute plantar fasciitis. Plantar fasciitis in its normal chronic state is inflammation of the plantar fascia that causes heel and arch pain. But (Manning), by reports it sounds like, he had been dealing with some plantar fascia pain, but then it had progressed to this acute partial tear and that’s a little bit different. That’s a partial tear of the plantar fascia that causes pain and swelling where you tear part of the fascia.

HOW DOES IT PROGRESS FROM PLANTAR FASCIITIS TO ITS CURRENT STATE FOR PEYTON MANNING?

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. Sometimes chronic plantar fasciitis is treated with cortisone injections and although that decreases the pain sometimes, it causes weakening to the fascia and that can then result to a tear if they put enough force to it.

SO WHAT EXACTLY IS THE PLANTAR FASCIA?

The plantar fascia is a broad ligament that extends from the heel to the toes that supports the bottom of the foot. A tear of that ligament causes pain and swelling in the heel and through the arches of the foot. Patients can have this injury acutely or chronically, but according to the reports, he suffered an acute partial tear meaning that part of the ligament ripped. Typically that causes a great deal of pain, even more than a complete tear of the plantar fascia.

HOW ARE THEY ARE TYPICALLY TREATED? (THOUGH WE SHOULD NOTE ONE DOCTOR TOLD USA TODAY SPORTS THAT IF MANNING COULD MANAGE THE PAIN HE COULD PLAY.)

Typically, you immobilize the foot in a boot, restrictions on activities, anti-inflammatory medications, ice and physical therapy. Patients typically walk on the foot while they wear that boot initially and then as they go to through the healing process, they’re slowly weaned out of the boot and into a supportive sneaker. A number of athletes have had this — Eli Manning had a complete tear of his plantar fascia and Paul Gasol had some fascia problems so it’s gotten more press in the past few years.

Patients are usually able to walk on the foot immediately in the boot with discomfort and over time it gets better and with rehab it gets better but to return to a high-level activity like to play football, I usually see athletes out 3-6 weeks for this.

WHAT CAUSES IT? DOES IT HAVE ANYTHING TO DO WITH HIS NECK SURGERY?

I don’t think it’s related to his neck and his back problems. All sorts of people get plantar fasciitis. Fat people, skinny people, you know high-arched people and flat-footed people. All types of people get it, it doesn’t discriminate to one type of person. Sometimes it’s related to other injuries, but it’s typically not related to a neck or back problem.

IS IT RELATED TO HIS AGE?

I don’t think so. I see a lot of younger patients who have the same problem and condition and I don’t necessarily see more older patients who have it than younger patients.