Plantar fascia ruptures are most frequently experienced by runners and athletes who engage in jumping sports, though they may also occur due to chronic plantar fasciitis.
Current conservative treatment includes 2-3 weeks of non-weight bearing in a boot/cast, ice, anti-inflammatory medication, and physiotherapy – proven effective even among elite athletes.
Symptoms
Plantar fascia rupture occurs when the fibrous band of connective tissue on the bottom of your foot breaks, damaging its arch support and shock absorption mechanisms when walking, running, or jumping. Plantar fasciitis occurs when overused, leading to inflammation and pain – this condition is known as plantar fasciitis. Over time, ligaments become weaker and rupture. When this happens, pain and stiffness manifest themselves when you stand or walk – this symptom typically appears upon standing or stepping up from a sitting or lying position. It usually peaks first thing in the morning or after prolonged sitting. Over time and once movement resumes, this pain may lessen; in more severe cases, however, plantar fascia tears could result in limps or an inability to bear weight on one foot.
Plantar fascia rupture is not uncommon and occurs across all age groups, from children to athletes and non-athletes alike. It is most prevalent among runners as their footfalls are constantly under tension as each step takes them further uphill. Diagnosing ruptures is often tricky due to plantar fascia not having the flexibility of muscles to stretch when placed under pressure; left untreated; this condition may result in a complete break requiring surgical repair for alleviation.
Most cases of plantar fascia rupture result from direct trauma to either the heel or arch of the foot, such as falling from a height and landing directly on it or repetitive impact with activities like daily running or walking. People with flat feet have an increased risk of plantar fascia rupture due to less stable feet requiring extra support from their plantar fascia lining.
Treatment options for both complete and partial plantar fascia tears typically involve rest, icing, anti-inflammatory medication, activity modification, and physical therapy/stretching exercises to strengthen and increase flexibility to decrease re-injury. Recent advances such as Platelet Rich Plasma (PRP) injections or amnion injections have also proven highly successful in improving outcomes of those suffering plantar fascia injury.
Diagnosis
The plantar fascia is a non-contractile band of tissue extending from the inner side of your heel bone to the arch of your foot, providing stability on the underside of your foot and medial longitudinal arch (MLA). As you walk, run, or hop, this fibrous band absorbs shock absorption while stabilizing heel position – when overloaded, it may become inflamed, leading to Plantar Fasciitis; over time, this inflammation could even result in rupture of this part of the fascia.
Pain is often the first symptom of a plantar fascia rupture. This pain typically appears at its attachment point on the calcaneus, making standing, walking, or jumping on hard surfaces excruciatingly painful. Although symptoms may fluctuate throughout the day, they usually flare up first thing in the morning or after rest periods and worsen over time; some patients describe a “tearing” sensation when placing weight on their feet.
Diagnosis typically begins by taking a history and conducting a physical exam, where your healthcare provider will look for tender areas on your foot and order X-rays or an MRI to rule out another cause for your heel pain. An MRI can confirm a ruptured fascia injury and show any surrounding swelling, potentially as edema (swelling).
At first, the focus should be on pain control with ice and relative rest. Some patients may require crutches or walking boots to alleviate weight-bearing on the injured foot. Once the pain subsides, gentle plantar fascia stretching should begin. A custom orthotic may relieve pressure off this vital tissue and speed healing time.
Platelet-rich plasma (PRP) injections may be recommended in later stages of plantar fascia rupture by healthcare professionals. PRP injections have demonstrated promising results for decreasing heel pain and hastening recovery, although further research needs to be completed before being recommended as standard care for plantar fascia rupture.
Treatment
Plantar fascias are one of the critical structures that support our foot arches when weight bearing, yet can often rupture, resulting in heel pain. Symptoms may be sharp and sudden upon first step or prolonged sitting – although typically lessened with movement around.
Physical Therapists or Sports Medicine doctors usually find it easy to make a diagnosis based on patient history and physical exam. Sometimes, an Ultrasound or MRI may also be recommended to confirm the diagnosis and rule out other causes for heel pain.
Most plantar fascia ruptures occur due to acute injuries during dynamic activities, typically jumping or running and landing with direct force onto the arch area of their feet. Individuals with flat feet are at increased risk for this kind of rupture.
On examination, patients will have a point of maximum tenderness on the bottom of their heel and along the proximal plantar fascia, also marked by swelling and bruising.
Plantar fascia injuries should generally be managed conservatively with rest, ice packs, stretching, and activity modification. Custom orthotics may also help relieve pressure off the plantar fascia to facilitate recovery; patients can gradually resume activities over several weeks to months, depending on the level of activity involved.
Emerging treatments for plantar fascia injuries include platelet-rich plasma (PRP) and amnion injections. PRP is a concentrated solution of platelets from a patient’s blood that can aid healing and accelerate tissue regeneration rates; amnion is tissue from the placenta that contains growth factors that modulate natural healing processes in the body. While more expensive than traditional steroid injections, they offer faster results without surgical incisions or pain.
Prevention
The plantar fascia is a thick ligament running along the bottom of your foot from heel to toe. It plays an essential role in creating your arch, absorbing shock when walking, standing, running, or jumping, and providing stability for your foot. This ligament can become painful when overloaded or stretched out (usually due to increasing activity levels); complete rupture could result in severe and debilitating heel pain.
Plantar fascia rupture is often the result of repetitive activities that place undue strain on your feet, such as running long distances, working on hard surfaces, or standing for extended periods. Additionally, individuals with flat feet or weak arch control muscles often suffer more significant stress on the plantar fascia.
Running, ballet dancers, and tennis players are especially susceptible to plantar fascia injuries due to the repetitive nature of their activities and their impact on the feet. Other risk factors for plantar fascia rupture include obesity, tight calf muscles, high arches, and lack of ankle dorsiflexion.
Plantar fascia tears usually happen where the ligament connects to the heel bone (calcaneus). They may be partial or complete ruptures; symptoms include severe arch pain when getting out of bed after sitting for long periods, walking, running, or jumping, climbing stairs without proper support, and wearing shoes with limited cushioning or support. The pain worsens with climbing stairs or walking barefoot.
Many individuals living with plantar fasciitis experience frequent episodes of inflammation, which, over time, weakens and destabilizes their tissue and makes rupture more likely. Furthermore, those who have had plantar fasciitis before may be more prone to suffering a fascia tear if corticosteroid injections cause it to become inflamed again, leading to further tears of their plantar fascia causing tears in that tissue.
Preventing plantar fascia injury involves resting the foot in question, limiting weight-bearing activities, applying ice to reduce swelling and pain by constricting blood vessels, stretching, physical therapy exercises to strengthen Achilles tendon and calf muscle strength, foot hurts as well as receiving Platelet-Rich Plasma injections can all help accelerate healing while decreasing risk of plantar fascia rupture.