Jimmy Graham's Foot Injury: Details, Fantasy Impact of His Torn Plantar Fascia

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistNovember 1, 2013

NEW ORLEANS, LA - OCTOBER 27:  Jimmy Graham #80 of the New Orleans Saints reacts after scoring a touchdown against the Buffalo Bills at Mercedes-Benz Superdome on October 27, 2013 in New Orleans, Louisiana.  (Photo by Chris Graythen/Getty Images)
Chris Graythen/Getty Images

Despite a diagnosis of a partially torn plantar fascia, New Orleans Saints tight end Jimmy Graham rewarded faithful fantasy owners in Week 8 by scoring two touchdowns.

Unfortunately, the condition is likely going to persist into Week 9 and beyond.

With that in mind, questions remain: Should fantasy owners keep him in their lineup? Should they sit him? What about entertaining trade offers?

To answer those and more, let's take a closer look at what, exactly, is going on in the Saints superstar's foot.

What Is the Plantar Fascia?

The foot is immensely complicated, containing dozens of bones, ligaments and tendons. Each structure must function at full capacity within the larger system, or the foot as a whole suffers.

In Graham's case, the problem lies within the arch.

The plantar fascia is a tough band of connective tissue that runs along the sole of the foot, connecting the calcaneus—or heel bone—to the bases of the toes.

By doing so, it stabilizes the arch of the foot and assists in coordinating the very complex biomechanics of normal gait.

Unfortunately, just like any other tissue in the body, the plantar fascia can inflame and even tear.

Plantar Fasciitis and Plantar Fascia Tears

A 2004 review in the Journal of Athletic Training by Lori A. Bolgla and Terri R. Malone sheds some light as to why plantar fasciitis may develop.

In the review, the authors offer multiple potential injury mechanisms. Most involve abnormal biomechanics of the foot, causing the accumulation of stress over time.

Chronic overpronation is one such proposal.

Foot pronation describes the normal slight inversion of the ankle upon contact with the ground while running. It allows for optimum shock absorption and distribution throughout the foot.

However, if an athlete walks or runs in such a way that his or her foot overpronates—when the ankle leans too far inward at impact—the plantar fascia must compensate and absorb more stress than normal.

In some cases, it may need to over-stretch to do so.

Over time, abnormal wear and tear on the plantar fascia—whether due to overpronation or some other biomechanical cause—leads to microscopic tearing of the tissue and, therefore, swelling, inflammation and pain.

Classically, the injury occurs at the base of the heel, where the many bands of plantar fascia come together. Many times, the exact underlying biomechanical or musculoskeletal problem producing the injury remains unknown.

Particularly severe forms of plantar fasciitis may eventually lead to frank macroscopic tears of the fascia itself, up to and including the complete rupture of the fibrous band.

Analyzing Jimmy Graham's Case

As mentioned above, Fox Sports' Jay Glazer reported Graham carries a diagnosis of a partial plantar fascia tear.

Exact medical details are not available to the public, but Glazer's report suggests Graham's injury is of the macroscopic variety.

Regrettably, the injury probably will not heal in the midst of a long NFL season. In fact, it could very well get worse before it gets better.


Tough tissues like fascia do not carry a robust blood supply—when compared to the skin, for example—and as such, healing often proceeds very slowly.

Impressively, Jimmy Graham dunked the football over the goal post while playing with a partial plantar fascia tear. Needless to say, he has a high pain tolerance.
Impressively, Jimmy Graham dunked the football over the goal post while playing with a partial plantar fascia tear. Needless to say, he has a high pain tolerance.Chris Graythen/Getty Images

By playing through a plantar fascia tear, Graham will continue to stress an already-damaged and weakened area of tissue.

In other words, his body's healing process will probably struggle to keep up with the demands an NFL season places on his foot. The resulting risks include further damage or a complete tear.

What does that mean in the big picture?

Simply, it all comes down to pain control.

Plantar fasciitis can make mere walking immensely painful—not to mention running, jumping and cutting. However, it doesn't necessarily compromise the foot's function.

Anti-inflammatory medications can help control the pain. Rest can also allow Graham's body to heal what it can during the week—likely the reason he is seeing limited work in practice, according to the Saints' injury report.

Fantasy Implications and Next Steps

If Graham can tolerate the pain with the help of treatment, he can play.

Nevertheless, pain can sometimes increase with prolonged activity, so it's very possible the Saints will continue to limit his snaps for a few weeks—according to ESPN.com's Mike Triplett, he saw fewer than 20 snaps in Week 8.

Additionally, the partial tear can complete at any time, as Bleacher Report's lead writer Will Carroll explains, which is both a good and bad thing:

With every step, the stretched and inflamed fascia could tear (or likely, tear further). This tear would release the pressure, but it would be intensely painful and cause a compromise in the foot. His arch would drop, often literally.

In the end, Graham will likely follow one of a few paths, such as:

  • Playing through the injury for the rest of the season and allowing it to fully heal during the offseason.
  • Playing through the injury for the rest of the season and then undergoing plantar fascia release surgery. During such a procedure, a surgeon precisely and systematically cuts the plantar fascia, relieving some of the tension and allowing the body's inflammatory process to settle down. Usually, the operation is a last resort for persistent symptoms despite conservative management.
  • Worsening or completing the injury midseason, likely leading to multiple weeks of missed time.

There are similarities between completing the tear and surgically releasing it. Carroll continued:

Surgery to correct the problem is almost the same thing (as a further tear), just cleaner and under sedation. The problem is fixed and the player can come back in four to six weeks. The Saints are hoping they can keep Graham healthy enough to stay on the field and have this procedure done after the season.

Whatever scenario will eventually come to pass remains unclear at this time, but the star tight end will probably take the field as long as he can manage the pain.

From a fantasy standpoint, barring an elite-level backup or media reports suggesting increasing concerns about pain—rather than stable or decreasing one—Graham remains a solid fantasy start whenever active. He is a consistent end-zone threat, as demonstrated by his two touchdowns in limited action on Sunday.

That said, it may be some time before owners see a double-digit-catch, 100-yard performance in the books once again.

Dr. Dave Siebert is a resident physician at the University of Washington. Find more of his work at the Under the Knife blog.

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