Dime Q&A: Expert Surgeon On Tyreke Evans & Plantar Fasciitis

[Sac.1989]

Good read this:

http://dimemag.com/2011/07/dime-qa-expert-surgeon-on-tyreke-evans-plantar-fasciitis/

For being a real menace, foot problems always get overlooked. If someone has knee surgery, it’s okay if they come back a little slow. They’re working themselves back into shape. If someone has a wrecked and twisted back, bash the maker for giving them back luck. We rarely hear anyone talk about feet outside of the mammoth one-timers like Yao Ming or Bill Walton. No one was supposed to ever get that big. Broken feet are only a byproduct. That’s the perception.
But smaller players can have their base taken out from under them too. Tyreke Evans‘ second NBA season was basically destroyed by plantar fasciitis.

Since ‘Reke went from having one of the best rookie years in NBA history to being cast as nothing more than a decent player – all in the span of one season – I had to question: how much did the injury play into his sophomore slump? So I caught up with Dr. Bal Raj, who was named “One of the Leading Physicians on the World” by the International Association of Orthopedic Surgeons (American & Canadian) and has tons of experience with athletes.
This is the third and final excerpt from an interview where we talked Kobe Bryant and his mysterious surgery, Gilbert Arenas and chronic knee issues and now Tyreke…
*** *** ***
Dime: Tyreke Evans dealt with plantar fasciitis all of last year. Could you talk and explain to us exactly what that is.
Dr. Bal Raj: Yeah. Plantar fasciitis is basically inflammation where the plantar fascia, meaning it’s the facsia underneath your foot below your flexors that connects from your toes to your heal area. So what happens is when this fascia gets inflamed, it gets inflamed near the heel area and it’s usually caused by number one, someone who is normally flat-footed because they have their plantar fascia on a constant stretch, and don’t have the normal arch. And number two on impact, for someone who jumps up and down like a basketball player. In general, the negative injuries have insertion at the heel. Your classic symptoms are pain when you get up and stiffness when you get up because what happens is all night when it’s inflamed, your foot actually flexes down and gets contracted. So when it actually gets contracted, the first step you take it the most painful step. Then, you start working it out.
It also usually happens in people who are overweight. So someone who has excessive weight and also a lack of a normal arch will be more prone to plantar fasciitis.

Dime: Is the injury unpredictable for athletes because it seems like it comes and goes with guys?
DBR: It is unpredictable. It’s set up in certain people. Certain people may innately have a solid arch and strong flexors so therefore they won’t load their plantar fascia as much. So in general, it is unpredictable who gets it, but at the end of the day the people you see who get it are usually people with normally a flat foot without a normal arch, number one, and number two, people who are excessively overweight who do a lot of jumping.

Dime: You mentioned the flat arch. Once you have the issue with plantar fasciitis, does it ever really go away or will you be dealing with it for the rest of your career?
DBR: The basic aspect of it is there are ways we can treat it, and even a surgical option is not the best. That’s actually not good at all. So surgical options, injections, and then there are products and arches which people can put in their shoes.
But the reality is if you are prone to plantar fasciitis, the likelihood is that you are going to get it on a recurrent basis. All you can really do is be preventive. A few preventative things that work aggressively with a trainer or physical therapist to stretch out your plantar fascia and strengthen your flexor tendons in your foot to kinda unload your plantar fascia, number one. Number two, when you sleep at night, wear a product that will actually keep your plantar fascia stretched so you won’t contract and be so inflamed in the morning. If you’re compliant with a program and a trainer, you will mitigate your frequency of getting plantar fasciitis.

Dime: If you play on it, will it develop into something worse? Obviously, it will hurt, but can it get any worse?
DBR: No, not usually. In general, what will happen is you will just create an alter blood supply where the plantar fascia attaches onto the heel, which is called the calcaneus. It will create a cycle of tendinosis. That’s number one. Number two, this is so painful that once you’re on it, it’s not the type of injury that you keep on playing on. You actually stop because it’s that painful, and you get treated.
So it’s not like a mild low-grade ankle sprain where if you just keep on jumping, you’re gonna fracture your ankle. This is like, once it’s active, you don’t wanna play. You wanna get this treated.

Dime: Over time as you get older, are there any long-lasting effects to it?
DBR: Yeah, long-lasting effects, obviously, the setup that causes this in most instances is weight and number two, a flat foot. In general, you’re gonna start overloading your smaller joints within your foot. So you will be more prone to arthritis in your foot, as well as your ankle.

 

[Glenn]

If you find anything on treatment from an expert, post it.

I have said most of this but don't have a big title after my name although I have half the title. This is a recurring problem and there is no cure. What Tyreke does in between games and even during games will lessen the effects.

Remember my skepticism about surgery. I am happy that I analyzed the data properly as despite the miracle cure being offered Tyreke, I was skeptical but swayed in the direction it was a good thing because the people suggesting this shock thereapy were so enthusiastic. Turns out that is only one school of thought and this specialist just quoted doesn't seem so enthusiastic.

I will continue to worry that this may plague Tyreke throughout his entire career and that it may be a severe limiter. For Tyreke in particular, it hurts like hell to jump. His specialty is the burst to the rim. That skill almost seemed to disappear last year and I do not think it was because of his ankle so much as the inflammation. Of course the ankle did not help but ankles heal. His inability to finish was because that last leap was limited and not because he doesn't have the skill to make a lay up. Perhaps he has lost up to a foot off that final step before the shot. That would explain TO ME why he has had such troubles with putting the ball in the basket. He is shooting from a different angle and from a lower spot from the rim.

This must be taken seriously. It can destroy the Tyreke of his rookie year and I don't mean for a year here and there but throughout his career. Many people have mentioned they have the same problem but no one is Tyreke who absolutely needs a trouble free plantar fascia. Let's not be naive and believe that he will just have had a bad year and now everything is OK. It is NOT OK. Tyreke must treat this problem as if it is his entire career that is online because it is.

I hope Tyreke understands.

 

[Kingsguy881]

Great news.

 

[Gliesian]

This sounds like Tyreke is going to be hampered by this for the rest of his life... Poor guy... brimming with skill and confidence but can't use it all. What a shame.

 

[Glenn]

The basic aspect of it is there are ways we can treat it, and even a surgical option is not the best. That’s actually not good at all. So surgical options, injections, and then there are products and arches which people can put in their shoes.

But the reality is if you are prone to plantar fasciitis, the likelihood is that you are going to get it on a recurrent basis. All you can really do is be preventive. A few preventative things that work aggressively with a trainer or physical therapist to stretch out your plantar fascia and strengthen your flexor tendons in your foot to kinda unload your plantar fascia, number one. Number two, when you sleep at night, wear a product that will actually keep your plantar fascia stretched so you won’t contract and be so inflamed in the morning. If you’re compliant with a program and a trainer, you will mitigate your frequency of getting plantar fasciitis.

This is the crucial paragraph. The question will be whether Tyreke is compliant with his trainer or physical therapist. I wonder if Tyreke is doing this. The fact that he is painless now is somewhat meaningless as it is a problem that comes and goes. How often it comes and goes is up to him. I care less about his jump shot than his feet. His jump shot makes no difference if he cannnot play.

Also if he has pain, he will be as he was last year. The pain limits the one unstoppable skill he has and reduces him to simply being a tall guard with no outside game and a limited inside game.

 

[Bricklayer]

This sounds like Tyreke is going to be hampered by this for the rest of his life... Poor guy... brimming with skill and confidence but can't use it all. What a shame.

You could get that from reading that article. You could. Whihc is also why this article caused me to raise an eyebrow. TONS of professional athletes have suffered through bouts of plantar fasciitis in their careers and gone on to rarely be bothered with it therafter. Even more people in regular life too. Its apparently no fun, but its hardly been classified as a lifelong debilitating disease...unless maybe you are a podiatrist tying to drum up work.

 

[Warhawk]

You could get that from reading that article. You could. Whihc is also why this article caused me to raise an eyebrow. TONS of professional athletes have suffered through bouts of plantar fasciitis in their careers and gone on to rarely be bothered with it therafter. Even more people in regular life too. Its apparently no fun, but its hardly been classified as a lifelong debilitating disease...unless maybe you are a podiatrist tying to drum up work.

I've had it. Both feet. About 10 years ago. Hurts like h***. All I do now is a little stretching of the bottom of each foot in the morning and I haven't been affected by it since. Now I am not a professional athelete by ANY means, but I am backing up what Brick said with a little anecdotal evidence.

 

[cuad]

He's saying what we knew all along.

Tyreke is a fatty.

 

[Dime Dropper]

He's saying what we knew all along.

Tyreke is a fatty.

I'll assume that that's tongue in cheek, although you never know with you.



Here's Tyreke on a few issues:

On the plantar fasciitis in his left foot that kept him out of 19 games late last season after he underwent a laser procedure in mid-February:

"I'm 100 percent. My foot is fine. I'm just looking for this year to start and to go out there and play. When it's time, I'll go out there and just play like I played my first year in the league. [Last season] I was [always] thinking about it."

On the new-look roster, which now includes veteran small forward John Salmons, young big man J.J. Hickson and rookie guard Jimmer Fredette, and no longer includes veteran point guard Beno Udrih and two-year small forward Omri Casspi:

"It's a great look. Young team, up-and-coming. We had a knock on us that we're always young, but you don't want to always keep hearing that. We want to be a winning team. We just added pieces to the puzzle.

"We've got Jimmer, who's a great player and can shoot from anywhere if you watch his highlights. We've got J.J., who's a great player from Cleveland, and we got Salmons, a great '3' man, a great wing man to have out there."

On whether he can blend his offensive style with that of Salmons, Fredette and guard Marcus Thornton (who is a restricted free agent but is expected to be re-signed):

"Definitely. I can score and I pass. I can do it all. I don't need to score. As long as we win, I'm happy. I've been winning all my life, and I'm not used to losing. We don't know yet [who will be the point guard]. The point or the shooting guard is good for me. I'm good at either spot, so if I get the ball on the rebound if I'm at the '2,' I get up and go and bring it up. Whatever coach Paul [Westphal] wants me to do, I'll do."

Read more: http://sportsillustrated.cnn.com/20...drew.league.notebook/index.html#ixzz1SE1815f1

http://sportsillustrated.cnn.com/2011/writers/sam_amick/07/15/drew.league.notebook/index.html

Tyreke is a smart guy. I trust him to take care of it. It's his body and his career, if we're worrying about it, I'm sure he is too.

 

[gunks]

I've had it. Both feet. About 10 years ago. Hurts like h***. All I do now is a little stretching of the bottom of each foot in the morning and I haven't been affected by it since. Now I am not a professional athelete by ANY means, but I am backing up what Brick said with a little anecdotal evidence.

I've also had it, about the same amount of time ago as well.

Got it from playing ball/doing silly freerunning stuff (well before the French made it "cool").

I've been pain free for about a decade now. And I dont even stretch. Although nowadays I dont do any high impact type stuff, so that could be part of why it hasnt come back for me.

As far as the article...

A bit worrysome. But Tyreke's feet are worth millions to him, I doubt he isnt going to do everything in his power to make sure to keep them as healthy as possible.

RE: Bricklayer's post... I was thinking that too. Leaves room for optimism, but I imagine that no two cases are alike. Didnt Noah have it a couple seasons ago? His feet seemed fine this past year (his injury had something to do with the hand/wrist IIRC).

I do think Reke needs to drop some weight though. Dude is strong. He doesnt NEED to outweight other guards by 25+ lbs. In fact it could help up the "trickseyness" of his drives if he drops down to 210-215. And that should help the ankles/feet.

 

[Sac.1989]

Just from another article i was reading;

http://www.slamonline.com/online/blogs/san-dova-speak-easy/2011/07/the-fit-cytosport-cytogainer/

In the case of Tyreke Evans, star guard of the Sacramento Kings, he gained mass in the summer of 2010, after he celebrated his Rookie of the Year award-winning season of ’09-10; after going up to 228 in the offseason with training, he came into the 2011 season with big plans, only to suffer a season-long bout of plantar fasciitis, which may or may not have been an effect of gaining unnecessary weight in the prior offseason.

 

[Telemachus]

Just from another article i was reading;

http://www.slamonline.com/online/blogs/san-dova-speak-easy/2011/07/the-fit-cytosport-cytogainer/

In the case of Tyreke Evans, star guard of the Sacramento Kings, he gained mass in the summer of 2010, after he celebrated his Rookie of the Year award-winning season of ’09-10; after going up to 228 in the offseason with training, he came into the 2011 season with big plans, only to suffer a season-long bout of plantar fasciitis, which may or may not have been an effect of gaining unnecessary weight in the prior offseason.

He weighed 221 lbs. coming out of college. I find it hard to believe that adding 7 lbs would make that much difference to his feet.

 

[est.1999]

He weighed 221 lbs. coming out of college. I find it hard to believe that adding 7 lbs would make that much difference to his feet.

Especially for someone that is 6'5"

 

[cuad]

He still had ankle problems at 221 lbs didn't he?

 

[Telemachus]

He still had ankle problems at 221 lbs didn't he?

He had some spained ankles. Show a basketball player who hasn't had some sprained ankles, and we will be looking at one of the luckiest people on the planet. Sprained ankles are just part of the game, plantar fascitis is NOT something that plagues everyone.

 

[Lockehead]

Hes had plantar fasciitis since college.

 

[rainmaker]

I'm curious as to where all the posters are who were so damn sure Reke's skills just evaporated last year, he fell off, and his foot had nothing to do with it. I remember countless times a few posters dismissing Reke's plantar fasciitis as a legit excuse when he played poorly.

I think some forget he was ROY, and I expect him to come back strong next year. Plantar fasciites doesn't normally hamper people year after year, and I think if Reke keeps his weight down, it won't be too much of a problem. I'm more concerned with his ankles, and that's the biggest reason he needs a midrange game, teardrops and floaters, so he doesn't need to bang into the defenders and put his ankle at risk so much. Interstingly, most of his ankle sprains have occured under the hoop, after crashing into a couple guys.

 

[Glenn]

If my notes sound pessimisic, it is perhaps an occupational trait. My point was to try to simply provide knowledge and also to accentuate that Tyreke has to be very mindful of his feet.

As to his weight, I don't think Tyreke's weight is an issue. I have a minor problem with plantar fasciitis myself but it is because I am fat. Not orca fat, but fat.

I have had thoughts similar to rainmaker as to how he should change his game to protect his ankles and feet. The major probelm is that Reke is Reke because of his ability to attack the rim. Taking that away from him may make him ordinary. In any case, the problems with his lower anatomy DOES mean he has another motivation to get that jump shot down. I have a pessimism about Tyreke that he doesn't get it. This is based on very little except he has never mentioned how he must take care of his feet when they are feeling fine. Prevention of the plantar fasciitis is key. No one knows if he will have a recurrence but we DO know he has had problems and therefore the future is more likely to contain another bout of a similar problem as opposed to someone who has never had it.

Whether or not other people have had it or not is interesting but Reke's feet and ankles ruined an entire year and I don't know how many people have resorted to the voodoo treatment he had. I don't recall any. Reke is Reke.

 

[William Blake]

As to his weight, I don't think Tyreke's weight is an issue. I have a minor problem with plantar fasciitis myself but it is because I am fat. Not orca fat, but fat.

For what it's worth I have a problem with plantar fasciitis too, and I'm 10 lbs underweight.

 

[Lockehead]

Im pretty skeptical about how much his feet really affects him. He had an awesome rookie year, and a subpar sophomore year which was blamed almost entirely on p.f., even though he had it in college and in his rookie year. So who knows except Tyreke, and maybe his agent. For all i know these foot issues might just be a scapegoat to protect his marketability and image until he resolves his true problems - low bbiq, overdribbling, one dimensional game, no jumpshot, etc.

 

[Agent23]

Im pretty skeptical about how much his feet really affects him. He had an awesome rookie year, and a subpar sophomore year which was blamed almost entirely on p.f., even though he had it in college and in his rookie year. So who knows except Tyreke, and maybe his agent. For all i know these foot issues might just be a scapegoat to protect his marketability and image until he resolves his true problems - low bbiq, overdribbling, one dimensional game, no jumpshot, etc.

He had P.F. his rookie season? Thats new to me. I know he sprained his ankles a few times but never knew his feet were hurt his rookie season.

 

[bajaden]

Im pretty skeptical about how much his feet really affects him. He had an awesome rookie year, and a subpar sophomore year which was blamed almost entirely on p.f., even though he had it in college and in his rookie year. So who knows except Tyreke, and maybe his agent. For all i know these foot issues might just be a scapegoat to protect his marketability and image until he resolves his true problems - low bbiq, overdribbling, one dimensional game, no jumpshot, etc.

Source?? I doubt if you have one, but if so, please post it. I've followed Evans for quite a while, including his year at Memphis, and I have no recolection of his having foot problems. There was no indication of foot problems his rookie year. Sprained ankles? Yes, but no foot problems. Obviously you have an agenda, and you'll use anything to move your agenda forward, while ignoring any facts that might get in your way. Childish at best. Dispicable and dishonest at worse.

Everyone is well aware of the flaws in Tyreke's game. He had those same flaws his rookie year, but still preformed well enough to win ROY. There are very few players that come into the NBA without flaws in their game. Where they go from there, is up to them and their god given abilities. But thats a separate issue from having an injury that prevents a player from using all his abilities. I've had my share of foot and leg injuries, and its not fun trying to play through them. In some cases you can't!

On a personal note, here's what bothers me about posts like yours. As a fan, sitting on the outside looking in. Which means no real inside information. I want nothing but the best for my team and the players on that team. I want every player on my team to be successful. When a player like Tyreke has a year like last year, and I'm presented with a reason for his less than stellar play, I'm certainly going to take that reason into consideration. Thats what a logical person should do. So I can't fathom the workiings of your mind. Nor do I want to. I would hope that you don't approach everything in life in a similar way. That would be sad..

 

[Lockehead]

I didnt mean to sound like a prick, but im just saying that none of us really knows how bad it is except for Tyreke. But yes if i recall correctly hes had the p.f. since college. Anyone remember Tyreke talking about this in interviews when his p.f. was a big media thing in his sophomore year? A quick google search didnt turn up any results but im positive i remember him talking about it in an interview (on video). I just find it weird how last season, it seemed as if whenever he had a good game, his ankle was feeling good, but when he goes on a streak of bad ones, his feet becomes a big issue. But then again, who knows.

edit: Heres the closest thing to a textual source i can find.
http://www.fantasysp.com/player/nba/Tyreke_Evans/1335044
But like i said i first heard Reke saying he had it in college in a video interview. Maybe other kingsfans has some recollection?

 

[bajaden]

I didnt mean to sound like a prick, but im just saying that none of us really knows how bad it is except for Tyreke. But yes if i recall correctly hes had the p.f. since college. Anyone remember Tyreke talking about this in interviews when his p.f. was a big media thing in his sophomore year? A quick google search didnt turn up any results but im positive i remember him talking about it in an interview (on video). I just find it weird how last season, it seemed as if whenever he had a good game, his ankle was feeling good, but when he goes on a streak of bad ones, his feet becomes a big issue. But then again, who knows.

edit: Heres the closest thing to a textual source i can find.
http://www.fantasysp.com/player/nba/Tyreke_Evans/1335044
But like i said i first heard Reke saying he had it in college in a video interview. Maybe other kingsfans has some recollection?

I followed Evans partially in highschool, where he played SF his senior year. He only played one year at Memphis, so there was no sophmore year. I followed him the entire year. He started out play SG, where to be honest, he wasn't very effective. Calapari switched him to PG and thats when he started playing well. Memphis didn't lose another regular season game with Tyreke at the helm. I remember no mention anywhere of him having any foot problems. I know Kingster and Larry Legend followed him as well, so maybe they can add something. But your going to have to come up with something better than your memory of an interview he gave in his sophmore season that he never played.

Here's some logic for you. His rookie season in the NBA he was terrific going 20/5/5. One of four players in NBA history to do so. Last season, at times he looked like a mere shell of himself when compared to his rookie season. He was diagnosed with plantar fasciitis of his foot. He sat out games at times because of the pain. When he did play, he would only be effective for parts of the game. He didn't move as quickly or jump as high. Not a good thing when your not known as great leaper to start with. As a result, he had problems finishing at the basket, which is his bread and butter. Now to this feable mind, logic tells me that the reason he didn't play as well, was because of his foot problem. Therefore I'm willing to do for him what I would do for any player in the league. Cut him some slack, and just write off the season as a wash.

But here's what your trying to do. You want it both ways. First you want to ignore the foot problem as a made up excuse and totally blame Tyreke for the bad season. But on the other hand, to cover all your bases, you want to say that he came to the Kings with the foot probem. Thereby painting him as a tarnished player that we probably shouldn't have drafted in the first place. I can deal with good critical analysis of a players season. But I can't deal with someone that ignores logic to benefit his analysis.

 

[Lockehead]

I meant his sophomore season in the NBA when his foot issue was the buzz in Kings media. That was when i heard Reke mention that he had the plantar fasciitis in college. I just have big doubts about how much the plantar fasciitis affected his game. I think the reasons for why he had a poor season have more to do with basketball than with his foot. Teams learned to set up their defenses to stop Tyrekes penetration. Lack of a jumpshot, bad decision making, and other basketball related maladies were why he had a hard season. Im not going to ignore that his feet could have something to do with it. But that discussion is a bit inconsistent. He took games off to rest his foot, and came back and he still had his good games and bad games. Then theres the personal problems, family issues. And as far as having some info from someone within the circle, Petrie had said that Reke was closer to not having the plantar fasciitis than having it at all.

edit: heres a quote from Tyreke from around the end of 2010 "It has nothing to do with the feet. It is not affecting my game. Getting to the cup and getting good looks I just gotta finish, it is more of me being frustrated," said Evans.
So at least until that point, his feet had no effect on him struggling.

 

[kennadog]

edit: heres a quote from Tyreke from around the end of 2010 "It has nothing to do with the feet. It is not affecting my game. Getting to the cup and getting good looks I just gotta finish, it is more of me being frustrated," said Evans.
So at least until that point, his feet had no effect on him struggling.

And I think this statement was more wishful thinking on his part. Any dedicated player thinks they should be able to play through almost anything, short of an amputation.

I think Reke should have stopped playing and gotten serious treatment much sooner than he did. Of course, that's easy for me to say, especially in hindsight. But I couldn't understand why he didn't just stop playing and get treatment, when it was clearly limiting him out there.