Albert Pujols' out for the season?

Albert Pujols has been suffering from plantar fasciitis for 6 or 7 years and reports indicate that he may have torn his plantar fascia last Friday.  He was placed on the disabled list and will be getting an MRI.  This MRI would reveal whether or not the fascia is torn.

I discussed Pujols' condition in an earlier blog post and it appears that the fascia may have degenerated enough causing a tear.  Tearing of the fascia may actually be beneficial for Pujols as the tension may be relieved from the ligament pulling at the heel bone.  However, a tear in the fascia is painful and requires time to heal.  A tear in the fascia may sideline him for the rest of the year.

Plantar fascia tear

The plantar fascia is a strong ligament on the bottom of the foot that helps to support the arch.  It attaches at the heel and fans out to attach to each of the toes.

A plantar fascia partial or full tear can occur in any of the bands, but the medial band (the band closest to the big toe) is the most common.  

Cortisone injections, which are commonly used to treat plantar fasciitis, can be the source of a plantar fascia tear, as they can often weaken the integrity of the plantar fascia.  Studies describing the incidence of a plantar fascia rupture after injection range from 2.4-22% (1-3).  Degeneration of the fascia may also play a role in a plantar fascia tear.  Patients suffering with plantar fasciitis for long periods of time eventually develop plantar fasciosis.  In this state, the plantar fascia thickens and develops scar tissue.  This thickening can cause a loss of integrity to the fascia, increasing its risk of rupture.  

Albert Pujols' case

In Pujols' case, he has been suffering from this problem on and off for 6 to 7 years and likely has plantar fasciosis.  If he had been treated with corticosteroids - as many athletes are - his risk of developing a partial tear may have increased as well.  Should Pujols have a partial tear in his fascia, he needs to be immobilized and the fascia needs to be supported.  Depending on the severity of the tear, he may be out 1 to 2 months recovering.

References:
1. Kim C, et al.  Incidence of plantar fascia ruptures following corticosteroid injection.  Foot Ankle Spec 2010; 3(6):335-7
2. Acevedo JI and Beskin JL.  Complications of plantar fascia rupture associated with corticosteroid injection.  Foot Ankle Int 1998; 19(2):91-7
3. Saxena A and Fullem B.  Plantar fascia ruptures in athletes.  Am J Sports Med 2004; 32(3):662-5