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An in-depth look at plantar fasciitis

An in-depth look at plantar fasciitis

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What's greater -- the number of 6-4-3 double plays turned by the Red Sox since they traded Nomar Garciaparra or the number of guys who have played shortstop for the Sox?

OK, so I'm guilty of a bit of hyperbole but it is fair to say that finding stability at that position has been the Sox's Achilles' heel. There was Orlando Cabrera, Edgar Renteria, Alex Gonzalez, Julio Lugo, Jed Lowrie and Gonzalez again, to name a few. It has, at times, been painful to watch the procession.

The latest to step into the role is Marco Scutaro, who signed a two-year deal earlier this month -- but not before the Sox were satisfied that the steps the 34-year-old would be taking were pain-free.

You see, Scutaro suffered from a foot problem last year -- plantar fasciitis. Now is probably a good time to share the anatomy lesson that Dr. Tom Lyons, a podiatric foot surgeon at Beth Israel Deaconess Medical Center in Boston graciously provides.

"The plantar fascia is a supportive thick band of tissue that extends from the heel, out along the bottom of our feet, and it eventually branches out and connects to our toes," Lyons explained. "It helps to maintain the arch in the foot, sort of like a tie beam you'd see in your attic or maybe a church. It ties the front (forefoot) to the rear foot (heel) and supports the arch, preventing it from flattening. The plantar fascia assists the foot in acting as a shock-absorbing mechanism when we walk and run."

When you consider the fact that the foot has to bear the entire weight of the body when we walk (even more when we run and jump), that shock-absorbing mechanism is a nice feature to have. When things aren't working properly, people tend to notice.

"Most patients I see will come in and simply say, 'My foot hurts.' That could mean any number of things," said Lyons. "When I ask them to describe the pain, I have a pretty good idea whether we are dealing with plantar fasciitis, which is an inflammation of the plantar fascia, or something else."

Lyons said that classically, these patients describe pinpoint pain just in front of the heel.

"Often the pain is worst just after stepping out of bed -- the first few steps of the day," Lyons said. "How quickly the pain goes away is a good indication of how severe the injury is.

In Scutaro's case, the pain was a factor from about midseason on. In a September ballgame, he went to field a grounder and "felt something pop" in his right heel. He missed the final two weeks of the season.

"Anybody who participates in an activity that puts a lot of load on their foot -- running, jumping, quick changes in direction -- increases their chances of a stress or overuse injury," Lyons said. "Normally, we would ask a person diagnosed with plantar fasciitis to modify their activity. If they play basketball or tennis regularly, they should try to back off for a little while. That's not always possible for a professional athlete."

The Sox sent a scout to watch Scutaro work out before the trade, and their medical staff gave the infielder a thumbs up before it all became official. Most likely, Scutaro is already taking steps to avoid a recurrence. Practicing that ounce of prevention can help you and me as well, according to Dr. Lyons.

"A tight Achilles' can pre-load the stress on the plantar fascia, so it's important to stretch your Achilles'," Lyons said. "I don't recommend standing on a step and dropping your heel. A better stretch is keeping your foot flat on the floor and knee straight as you lean toward a wall.

"Arch support is often necessary. You should definitely avoid bare feet and hard flat shoes. Raising the heel is good. Some of my women patients are very excited to hear that, but I also remind them that not all high-heeled shoes are made equal and can lead to other foot problems."

Well, at least that's not a problem that Scutaro will have to worry about. As long as he stays on his toes at shortstop, I think most Sox fans will be happy.

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.

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