Andy Carroll may need shock therapy

As Hammers fans wait patiently for the Andy Carroll return, we decided to get down with the medical evidence and examine what his injury really means in terms of prognosis for the future. So what exactly is Plantar Fasciitis, and what does it really mean for our current predicament?

Of course, many fans are worried that we may be dealing with another cruel Dean Ashton-like injury. In addition, folk are keen to know if this is likely to be a recurring problem - fans leaving Upton Park yesterday after another goalless performance by the Hammers will be wanting us to make sure we have other options from the blunt 4-6-0 formation we have had to endure in Carroll's absence!

First up, we know that he is suffering from a condition called plantar fasciitis - an annoying problem that affects as much as 10 per cent of the population but especially those who engage in activities that place strain upon the sole of the foot - runners, ballet dancers, basketball players as well as the overweight and the elderly.

The plantar fascia is a fibrous band that runs along the base of the foot from the back of the heel to the ball of the foot that serves to provide stability and support for the arches. Plantar fasciitis classically refers to inflammation of the band that can involve small 'micro' tears. However, other studies have highlighted that it is also an overuse injury and reflects wear of the band that is significant as it is thus likely to pose recurring problems. Hmmm.

So the condition presents with pain (especially at the heel) and with problems weight bearing on the arches. This is because the band is at its thinnest as it passes over the heel and especially prone to wear and tear at that point. Sufferers typically complain of intense pain through the heel after periods of rest (e.g. first steps of the day) as well as with activities that require landing on one's feet - such as jumping for a header in football.

The prognosis for plantar fasciitis is disturbingly variable - although most sufferers recover over 6-12 months, with the condition disappearing as mysteriously as it appeared, a significant number experience chronic problems. However, perhaps the most worrying aspect is that in addition to this unpredictability, the evidence for effective treatments is poor.

There is anecdotal evidence for short-term relief from rest, ice, heat, and massage but these seem best for temporary relief and have clearly not worked for our Andy. Anti-inflammatory drugs (such as Ibuprofen) can provide some temporary symptom relief but do not affect the longer term course of the condition. There is slightly better evidence to support the use of strengthening exercises with foot orthotics that provide foot support as well as night splints that stretch the band by pulling the big toe upwards.

A variety of injectable remedies exist ranging from anaesthetic agents, blood products and botox, but these are experimental and the best evidence is for steroid injections as a short to medium term remedy but these can also aggravate the condition and actually weaken the band.

For cases that prove resistant to the above treatments, typically after six months the options of shock wave therapy (to stimulate blood flow to the area) or fasciotomy (surgically remove the band) are considered. The former is still experimental but evidence is encouraging while the latter more extreme intervention is very effective in relieving pain but can affect the stability of the foot in the long term and is not readily reversible.

Andy spent much of September and October in the care of Lieven Maesschalck, director of the Move to Cure clinic in Antwerp, Belgium - a physical therapist who specialises in this type of injury. The subsequent utterances from the Boleyn have been cautiously optimistic in suggesting that Andy can return to action in the near future but without any clear date (read: he's still having symptoms!)

Unfortunately, the medical evidence is far from reassuring and although this is entirely different circumstance from the horrific traumatic injury that Dean Ashton experienced, it clearly is a problem that may pose a recurring challenge for the Hammers squad to work around and we cannot presume upon Andy's consistent availability. Sadly, the ?15million outlay is not looking such a wise move at this stage as even if he recovers we find ourselves having to work around an unpredictable injury.

In addition to being a Hammers fanatic, David Meagher is a doctor and provides occasional medical cover for Limerick FC in the League of Ireland. He is patiently waiting for the call up from the medical team at the Boleyn!

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