Jail officers accused of ordering an inmate beaten

Two Cook County Jail officers overseeing a psychiatric ward ordered two inmates to beat up another inmate who had angered them and then tried to cover it up by claiming the battered victim attempted suicide, prosecutors said Friday.

"This is what happens to you (expletive) when you step out of line. You disrespect us, we disrespect you," prosecutors said the officers announced to the entire tier after the beating last February.

Delphia Sawyer, 31, and Pamela Bruce, 30, both six-year veterans with the sheriff's office, were charged with official misconduct, obstructing justice, perjury and mob action. Judge Edward Harmening set bail at $50,000 each and ordered them to turn over any firearms.

A photograph taken of the victim, Kyle Pillischafske, on the day after shows he sustained two black eyes and severe swelling on his face. Prosecutors said the damage took place despite the officers yelling for the two inmates to hit Pillischafske with "body shots" so his injuries would be less visible.

The inmate's mother, Morgan Pillischafske, of Mount Prospect, told the Tribune that she was shocked when she learned about the beating and later heard from her son that he thought he was going to die. He had been doing well there, receiving treatment for his bipolar disorder while awaiting trial on an aggravated battery charge, she said.

"Not only did these guards mistreat Kyle, they took advantage of two other inmates as well, all because they were supposedly called a name," she said Friday in a telephone interview. "You have to have thicker skin than that."

Sawyer and Bruce were working the 3 to 11 p.m. shift in the psychiatric tier in maximum-security Division 10 when inmates tried to light a makeshift cigarette in an electrical outlet, sparking a small fire and cutting power to part of the tier, Assistant State's Attorney Nicholas Trutenko said.

The officers, believing Pillischafske was partly to blame, confronted him, prompting a heated exchange, the prosecutor said.

The officers instructed "two of the larger inmates" to go into his cell and beat him, Trutenko said.

Sawyer and Bruce are alleged to have stood watch while the two inmates struck Pillischafske in the face and head. They then joined in, hitting him with their radios and kicking him in the side, the prosecutor said.

To cover up their misconduct, the officers misled a supervisor to believe that Pillischafske hurt himself by banging his head against a shower wall during a suicide attempt, the charges alleged.

The two later lied repeatedly to a grand jury investigating the beating, Trutenko said.

After their arrest Thursday, both officers were stripped of police powers and suspended with pay pending an internal disciplinary hearing next week, said Frank Bilecki, the sheriff's spokesman.

A lawsuit filed by Pillischafske against the officers, the county and Sheriff Tom Dart is pending in federal court.

Bruce, of Chicago, and Sawyer, of Justice, are both married mothers of two and have no criminal records or disciplinary history with the Sheriff's Department, according to their attorneys.

Peter Hickey, Sawyer's attorney, noted she was in charge of a very volatile tier of "psychiatrically disturbed patients."

"These aren't choir boys from St. Patrick's parish," Hickey told the judge.

Pillischafske, now 19, was jailed at the time of the beating on a charge he intentionally caused a car crash in a botched suicide attempt, injuring a woman in the other car. He pleaded guilty a few weeks later to aggravated battery and was sentenced to probation, court records show.

Pillischafske's mother said despite her son's mental health issues, he is a "pretty likable kid" who loves music, plays bass guitar and is hoping to go to college.

"Kyle needs to move on from this," she said. "The whole thing was very unfortunate."

jmeisner@tribune.com

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Storm begins to coat Chicago area with snow

CAPTIONS

Tears
A tear drops from the eye of DePaul University student Sam Henning as she is hit by a stiff breeze on West Wacker Drive. Tears protest eyes from drying out in cold, windy weather. (John J. Kim, Chicago Tribune /February 19, 2013)

Staff report

12:51 a.m. CST, February 22, 2013

Between and inch-and-a-half and two-and-a-half inches of snow has fallen across much of the Chicago region, though the snow is expected to turn to freezing drizzle in the next couple hours.

Meteorologists have scaled back their predictions on snow fall totals from the storm, though.

Illinois State Police described conditions as "horrible" and have responded to about 15 crashes already.

State Police are in a "snow plan" and aren't responding to accidents without injuries - those are supposed to be reported later.

"It will be tapering off from the south in the next couple hours, possibly some freezing drizzle across whole area," said Mark Ratzer, meteorologist for the National Weather Service. "We may end up coming in a little less."

The city of Chicago has sent 199 plows to work clearing main thoroughfares, according to the streets and sanitation department.

Check back for more information.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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United takes Dreamliner off schedule until June

The All Nippon Airways Dreamliner 787 arrives at Mineta San Jose International Airport. (Gary Reyes/San Jose Mercury News/MCT / January 22, 2013)

Staff and wire report

1:35 p.m. CST, February 21, 2013

The parent company of United Airlines says it is taking the Boeing 787 off its schedule through June 5 for all but one of its routes.

United Continental Holdings Inc. said it still plans to use the 787 on its flights between Denver and Tokyo's Narita airport starting May 12. It had aimed to start that route on March 31.

United, currently world's largest airline and the only U.S. customer for the 787, said the timing of that reinstatement will depend on resolution of the Dreamliner's current issues.

The 50 Dreamliners in commercial service were grounded worldwide last month after a series of battery-related incidents including a fire on board a parked plane in the United States and an in-flight problem on another jet in Japan. United had only been flying the plance since November.

Sources told Reuters earlier this week that Boeing Co. has found a way to fix the battery problems that involves increasing the space between the lithium ion battery cells.

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Tribune exclusive: 'We were just regular parents who were slapped in the face'

The parents of slain teen Hadiya Pendleton talk about her life and death and the issues raised after she died. (Chris Walker/Chicago Tribune)

11:57 p.m. CST, February 20, 2013

Hadiya Pendleton’s parents haven’t had much time to reminisce about their daughter’s life and death before Wednesday, when they sat down for an exclusive interview with the Tribune.

Cleopatra Cowley-Pendleton recalled getting the phone call on Jan. 29 that her 15-year-old daughter had been shot, and rushing to the hospital only to find out it was too late, her daughter was dead.

A whirlwind of activity followed as Hadiya became a national symbol of gun violence and her parents traveled to Washington for President Barack Obama’s State of the Union speech.

“I’m not going to be extremely political, but if I can help someone else not go through what we’ve gone through, then I have to do what I can,” Cowley-Pendleton said. “These are the cards we have been dealt. If these are the shoes I need to walk in, I don’t mind walking in them.”

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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OfficeMax, Office Depot agree to merger

Office Depot to buy Office Max as an attempt to compete with Staples.

Office Depot Inc. and Naperville-based OfficeMax Inc. confirmed Wednesday that they're planning to merge but left some key questions about the deal unanswered.

The all-stock deal calls for Office Depot to issue 2.69 new shares of common stock for each outstanding common share of OfficeMax. But officials declined to say where the newly merged company would be headquartered, who would sit in the CEO seat or even what it would be called.

OfficeMax CEO Ravi Saligram and Office Depot CEO Neil Austrian presented a united front during a Wednesday conference call with analysts, taking turns to explain the specifics of the deal.

"It takes two to tango," Saligram said. "Lo and behold, Neil and I have decided to tango."

The announcement of a merger, which Saligram said would "create a stronger, more global, more efficient competitor," put to rest years of speculation about a deal. The merger would unite the No. 2 company in the stationery and office supplies industry, Boca Raton, Fla.-based Office Depot, with the No. 3 company, OfficeMax, headquartered off Interstate 88.

A merger between the two chains "has made sense for years," Credit Suisse analyst Gary Balter wrote in a note this week.

Market leader Staples also would benefit from a merger, BB&T Capital Markets analyst Anthony Chukumba said.

"Clearly, you can't make this deal work unless you close a bunch of stores," he said. "Store rationalization is long overdue, and Staples will clearly benefit from just having fewer stores to compete with."

OfficeMax, with about 29,000 employees, operates 978 stores, including 10 in the Chicago area. Office Depot has about 39,000 employees and operates 1,675 stores, including seven in the Chicago area.

The two CEOs wouldn't say how many stores would be closed, but Balter has predicted about 600.

If the merger is completed, the company's board would have an equal number of directors chosen by Office Depot and OfficeMax. Based on Wednesday's stock closing price, the deal's value is about $976 million.

The combined company would have $18 billion in sales and achieve $400 million to $600 million in savings over three years, according to company officials.

Office Depot shareholders would own about 54 percent of the company and OfficeMax shareholders 46 percent.

It was not clear, though, whether those stockholders would be satisfied with the deal. One of OfficeMax's largest shareholders, Neuberger Berman, said this week that it would support a deal, depending on the terms.

The deal also is subject to approval by regulatory agencies, including the Federal Trade Commission.

Officials declined to say who would lead the combined business or where it would be located once the "merger of equals" is completed, likely by the end of the year.

"During the appropriate times ... our board will make the right decision," OfficeMax's Saligram said. "Now, we're independent companies, and we've got to go through lots of processes."

Saligram and Austrian will be considered to lead the company, but until a leader is chosen, they will remain in their positions.

"From the time we started talking, Ravi and I have grown very fond of each other. It's very clear we can work well together," Austrian said.

Their proposed partnership didn't begin well. The announcement of the planned merger was buried in an earnings release posted prematurely on the Office Depot website early in the morning, then quickly removed. The companies recovered, and about 8:30 a.m., they issued a joint statement announcing the proposed merger.

The mishap will likely be investigated by stock exchanges and regulatory organizations, according to a Chicago financial attorney.

"I am highly confident that the New York Stock Exchange, the Nasdaq and the Securities and Exchange Commission will be looking very closely at who pulled the trigger, who knew about this, and was this in good faith?" James McGurk said.

McGurk said he was not suggesting wrongdoing.

"When you think about it, you have two boards, lots of investment advisers, lawyers, and deals break down at the last minute. Are there lots of ways it could happen? Sure," he said.

OfficeMax shares closed Wednesday down 91 cents, or 7 percent, at $12.09. Shares of Office Depot closed down 84 cents, or nearly 17 percent, at $4.18.

Reuters contributed.

crshropshire@tribune.com

Twitter @corilyns

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AMPAS drops “85th Academy Awards” – now it’s just “The Oscars”

LOS ANGELES (TheWrap.com) – The upcoming Academy Awards show is the 85th, a significant anniversary that in past years might have brought a reunion of past winners, special film clips or some sort of recognition on the Oscar show.

But this year, the number 85 has been quietly retired, and so has the phrase “Academy Awards.”

Both disappeared from official AMPAS materials about three weeks ago. “We’re rebranding it,” Oscar show co-producer Neil Meron told TheWrap on Monday. “We’re not calling it ‘the 85th annual Academy Awards,’ which keeps it mired somewhat in a musty way. It’s called ‘The Oscars.’”

During TheWrap’s interview with Meron and his partner Craig Zadan, Meron said they were under the impression that the new approach would continue in the future.

Academy spokeswoman Teni Melidonian confirmed that the change has happened for the upcoming show, but described it as the kind of typical adjustment in the ad campaign and overall message that takes place every year in consultation with the show’s producers and the network, ABC.

“It is right for this show, but we could easily go back to using ‘Academy Awards’ next year,” she said.

The majority of the show’s posters and advertising materials focus on host Seth MacFarlane and the phrase “The Oscars,” with no mention of how long the Academy has been hosting this shindig and no use of the phrase “Academy Awards.”

And Academy press releases dealing with the upcoming show, which used to routinely mention the number, stopped doing so around the beginning of February. The last such AMPAS release appears to have come on January 29; since then, every release has found ways to avoid the phrase “85th Academy Awards.”

When initial voting began, for example, the Academy’s December 14 release began, “Nominations voting for the 85th Academy Awards will open at 8 a.m. PT, Monday, December 17 … “

But when final voting began seven weeks later, its release said this: “Final voting for the Oscars will officially open on Friday, February 8th at 8 a.m. … “

The phrase “The 85th Academy Awards,” which used to begin the last paragraph of most Oscar-related press releases from the Academy, has been replaced with “Oscars for outstanding film achievements of 2012.”

It’s hard to say that the Academy is completely turning its back on its history, given that this year’s show includes a celebration of the 50th anniversary of the James Bond movies and a tribute to movie musicals of the past decade. But it is consciously (if quietly) looking not to use a big round number when trying to woo viewers closer to the age of Quvenzhane Wallis (9) than Emmanuelle Riva (85), and trying to get less formal by making the show’s nickname its official name.

“It’ll be like the Grammys,” said Meron. “The Grammys don’t get a number, and neither will the Oscars.”

He’s not exactly right: The top of the Recording Academy’s Grammy page (right) is headed, “The 55th Grammys,” and the number appears in the first sentence of most NARAS press releases.

The Oscar.com page, on the other hand, just says “The Oscars.”

For this year, at least.

Movies News Headlines – Yahoo! News

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Well: No Consensus on Plantar Fasciitis

Phys Ed

Gretchen Reynolds on the science of fitness.

There are more charismatic-sounding sports injuries than plantar fasciitis, like tennis elbow, runner’s knee and turf toe. But there aren’t many that are more common. The condition, characterized by stabbing pain in the heel or arch, sidelines up to 10 percent of all runners, as well as countless soccer, baseball, football and basketball players, golfers, walkers and others from both the recreational and professional ranks. The Lakers star Kobe Bryant, the quarterback Eli Manning, the Olympic marathon runner Ryan Hall and the presidential candidate Mitt Romney all have been stricken.

But while plantar fasciitis is democratic in its epidemiology, its underlying cause remains surprisingly enigmatic. In fact, the mysteries of plantar fasciitis underscore how little is understood, medically, about overuse sports injuries in general and why, as a result, they remain so insidiously difficult to treat.

Experts do agree that plantar fasciitis is, essentially, an irritation of the plantar fascia, a long, skinny rope of tissue that runs along the bottom of the foot, attaching the heel bone to the toes and forming your foot’s arch. When that tissue becomes irritated, you develop pain deep within the heel. The pain is usually most pronounced first thing in the morning, since the fascia tightens while you sleep.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

It was thought that by running or otherwise repetitively pounding their heels against the ground, people strained the plantar fascia, and the body responded with a complex cascade of inflammatory biochemical processes that resulted in extra blood and fluids flowing to the injury site, as well as enhanced pain sensitivity.

But instead of lasting only a few days and then fading, as acute inflammation usually does, the process can become chronic and create its own problems, causing tissue damage and continuing pain.

This progression is also what experts believed was happening when people developed chronic Achilles tendon pain, tennis elbow or other lingering, overuse injuries.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.

“Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

Instead, plantar fasciitis more likely is caused by degeneration or weakening of the tissue. This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. That is the point of exercise training.

But sometimes, for unknown reasons, this ongoing tissue damage overwhelms the body’s capacity to respond. The small tears don’t heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts.

By and large, most sports medicine experts now believe that this is how we develop other overuse injuries, like tennis elbow or Achilles tendinopathy, which used to be called tendinitis. The suffix “itis” means inflammation. But since the injury isn’t thought to involve chronic inflammation, its name has changed.

This has not yet happened with plantar fasciitis, and may not, given what a mouthful fasciopathy would be.

The evolving medical opinions about plantar fasciitis matter, beyond nomenclature, though, because treatments depend on causes. At the moment, many physicians rely on injections of cortisone, a steroid that is both a pain reliever and anti-inflammatory, to treat plantar fasciitis. And cortisone shots do reduce the soreness. In a study published last year in BMJ, patients who received cortisone injections reported less heel pain after four months than those whose shots had contained a placebo saline solution.

But whether those benefits will last is unknown, especially if plantar fasciitis is, indeed, degenerative. In studies with people suffering from tennis elbow, another injury that is now considered degenerative, cortisone shots actually slowed tissue healing.

We need similar studies in people with plantar fasciitis, Dr. Khan said. “They have not been done.”

Thankfully, most people who develop plantar fasciitis will recover within a few months without injections or other invasive treatments, Dr. Philbin said, if they simply back off their running mileage somewhat or otherwise rest the foot and stretch the affected tissues. Stretching the plantar fascia, as well as the Achilles tendon, which also attaches to the heel bone, and the hamstring muscles seems to result in less strain on the fascia during activity, meaning less ongoing trauma and, eventually, time for the body to catch up with repairs.

To ensure that you are stretching correctly, Dr. Philbin suggests consulting a physical therapist, after, of course, visiting a sports medicine doctor for a diagnosis. Not all heel or arch pain is plantar fasciitis. And comfort yourself if you do have the condition with the knowledge that Kobe Bryant, Eli Manning and Ryan Hall have all returned to competition and Mr. Romney still runs.

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