How Peyton Manning's injury will be treated and could be a cyclical problem

After reportedly battling plantar fasciitis in his left foot for several weeks, Denver Broncos quarterback Peyton Manning now has a tear in the plantar fascia of his left foot. It’s not uncommon for a chronic irritation of the tissue to progress to a tear; the question now becomes just how well Manning can function with the injury.

The plantar fascia is the fibrous tissue along the undersurface of the foot which runs from the heel to the ball of the foot and reinforces the arch. It is placed under tension every time the foot hits the ground as body weight is loaded through the leg. Microtrauma to the plantar fascia results in the painful condition known as plantar fasciitis. When severe, even walking becomes excruciating, and athletes often describe it as “walking on broken glass.”

Progression of the injury can result in tearing of the plantar fascia, in the form of either a partial tear or a complete rupture. Partial tears are often more difficult to manage due to the nagging pain associated with them, pain that can escalate whenever load is placed through the foot. Even if the symptoms eventually quiet down, another flare-up can be just around the corner, making this a potentially cyclical problem. Complete ruptures are very painful initially but once the tissue is allowed to scar down and heal, the recovery process is generally more linear and more complete.

One of the primary treatments for this condition is rest to decrease the load on the plantar fascia although various measures of splinting, taping, stretching, strengthening and footwear modifications are often incorporated. Platelet-rich plasma injections can also be utilized with the hope of creating an enhanced healing environment for the plantar fascia. There is no standard timeframe for recovery and it can often take weeks or months for full resolution. Typically an athlete will be allowed to resume play when the symptoms permit and when he can function without limitation.

The bottom line is that in the presence of a plantar fascia tear, every movement that puts weight through the leg is painful. Manning will be challenged in all aspects of his play as long as the symptoms are present. Late last season his delivery was impacted by a left quad injury when he had difficulty fully transferring his weight through his leg as he threw. Weight transfer will certainly be no easier with this injury. Manning, who hasn’t missed a game in any of the 16 seasons in which he has played (he sat out the entire 2011 season following neck surgery), is as tough as they come, but he has already been ruled out for this weekend's game at the Chicago Bears and could miss more time.