PAU'S PAWS: Gasol to IL with Plantar Fasciitis

Something may be very wrong with Pau Gasol's foot.

On Tuesday 1/25, Gasol was placed on the IL, meaning that he will miss a minimum of five games.

AP has the precision to call the injury an "injured left foot." Other outlets describe the injury as a "sore foot." And yet, Mike Fratello thinks that Gasol could miss "at least two weeks" with the injury. Interesting...

It seems, upon closer inspection, that Gasol has plantar fasciitis in his left foot. Big ups to the Seattle Post-Intelligencer.

There are a few disturbing things about this injury.

First of all, it's chronic. This is the kind of thing that a player struggles with throughout entire seasons, and most are able to overcome of it with a lot of good, old-fashioned lip-biting. It's not specific to basketball; many will remember that Albert Pujols struggled with this injury for the entire 2004 season. The numbers suggest that it didn't hurt him that badly, but he's still complaining about it going into spring training.

And Gasol, unlike Pujols, has never (perhaps unfairly, seeing his relative health this far), had a reputation as a particularly tough guy. Because of his "finesse"-based offensive game (and probably his Spanish heritage), Gasol has picked up the nickname "Picasso." You see what I'm getting at here. That being said, basketball players also have to pound the hardwood, night-in and night-out; Pujols basically got to stand on first base and trot around the bases, and he's still talking about how excruciating the pain was, and regretting that he didn't have surgery earlier.

Last year, perhaps you'll recall, Wally Szczerbiak missed 53 games with the plantar fasciitis.

Rashard Lewis was diagnosed with it in the offseason, and was extremely worried about it. But he came out like a house on fire this season, and has only recently been slowed by knee tendinitis.

When Kobe Bryant went on the IL 11 days ago with a sprained ankle, he also revealed that he had also been playing the entire season with a sore foot due to--what else?--plantar fasciitis. Kobe's got something to prove this year, insists he can play through it, and says that despite playing 43.1 minutes per game, it's actually gotten better as the season has gone on. That's good for Kobe.

It isn't good that Gasol is going to miss "at least two weeks" with this injury. It's even more unfortunate for Gasol because it is the first time he has gone on the IL in his career.

Let's put it like this. If Marcus Camby came down with a case of plantar fasciitis, he'd probably be in a wheelchair right now.

What makes it more disturbing is that Pau missed four games at the end of last season with an injury described, in similarly vague terms, as a "foot injury." The linked article, published on NBA.com last April, as the Grizz headed into the third game of their playoff series with San Antonio, describes Gasol as "hobbling into the postseason."

It's interesting to note that Gasol's 103 game streak of scoring in double figures ended on January 19 against Phoenix. He struggled to 5 points on 2-6 shooting.

Two nights later at, at Denver, Gasol made it a habit, playing only 26 minutes and scoring only 8 on 4-12 shooting.

On Jan 22, the scoring was back up to 23, but the minutes stayed low, at 27, and he grabbed only 3 boards.

Over his last five, Gasol is averaging 5.6 boards and 1.0 blocks on 44.8 shooting. Those aren't Gasol numbers. When dude can't jump, dude can't dunk, dude can't block, dude can't board. The whole game suffers.

What's even more disturbing (can you even handle any more disturbance?) is that Pau's younger brother Marc is also suffering right now from a mysterious foot injury.


Marc Gasol

The younger Gasol, a promising young post player for the very-dominant FC Barcelona of the Euroleague, went out in December and was expected to stay out for close to two-and-a-half months. Young Marc was diganosed with the injury after having begun the AFB season on the IL with a small fracture in his foot (fracture is one of the differential diagnoses for plantar fasciitis). He just opted not to have surgery on the foot, and is now seeing a specialist in Croatia. It sounds like a slam-dunk case of plantar fasciitis.

Be glad that you aren't a Gasol owner right now, because there's a lot of uncertainty and a lot of smokescreening around this out-of-nowhere injury right now.

Plantar Fasciitis

The plantar fascia is a thin layer of tough tissue supporting the arch of the foot. Presumably, the plantar fascia is "tougher" in some than it is in others, pain thresholds being equal. It is worn down by repetitive stress, and when its torn many times over, plantar fasciitis results:

Symptoms usually resolve more quickly when the time between the onset of symptoms and the beginning of treatment is as short as possible. If treatment is delayed, the complete resolution of symptoms may take 6-18 months or more.

I doubt Gasol will be out six months; I don't think he'll be out for three months.

But if I owned him, I'd be worried, and I'd be worried about reduced production even when he does come back. The severity and duration of this injury are influenced by the anatomical structure of the foot and leg: people with very flat feet or very high arches are especially prone, as are those with tight calf muscles, which inhibit the flexing of the ankle. Because plantar fasciitis changes the way you walk, associated foot (see: Kobe), knee (see: Rashard Lewis), hip and back problems (see: Kobe) often develop as a consequence.

Although the pain of plantar fasciitis occurs in the heel ("heel spurs" is usually a colloquialism for plantar fasciitis, and plantar fasciitis is often misdiagnosed for the much-less-serious "heel spurs"), it is not caused by the heel striking the ground.

Scott's Online Book does a better job of explanation than I can:

When walking and at the moment the heel of the trailing leg begins to lift off the ground, the plantar fascia endures tension that is approximately two times body weight.   This moment of maximum tension is increased and "sharpened" (it increases suddenly) if there is lack of flexibility in the calf muscles. A percentage increase in body weight causes the same percentage increase in tension in the fascia.

What Scott's saying is that it isn't good news that Pau has visibly been in the weightroom since entering the league as a stringbean: it increases this injury's chances of coming and staying.

Rest, and lots of it, is the best medicine for this injury, but surgery is required in some cases. Typical recovery time is closer to two months than two weeks.

The Spin

Foot injuries are a bitch, because they recur, and are usually structural in nature.

On a personal, anecdotal level, I knew Curtis Borchardt in college, and watched him endure two major foot surgeries in two years because of repeated fractures. He was already coming off of one foot injury when he walked in the door at Stanford. After he left early for the NBA, he missed his entire rookie season because of a new stress fracture.

Another player known to have had repeated foot problems because the structure of his foot predisposed him to reinjure it is Cleveland's Zydrunas Ilgauskas. For his third surgery, Big Z opted for a more radical procedure called "osteotomy," in which the bones of the foot are actually broken, cut, and recontoured to distribute pressure more evenly along the entire foot.

Let's hope that there's no structural problem with Pau's foot. It would be unwise, however, to discount that possibility. Make and review trade offers accordingly.

If you believe that chronic physical ailments and bone structures travel in bloodlines, you should be extra worried about Pau's future this season.



The Dime Dropper