What is a plantar fascia rupture?
A rupture of the plantar fascia is a rip or tear in the thick plantar fascia ligament on the bottom of the foot. The tear can be complete (complete rupture) or just a portion of the fascia may tear (partial rupture).
What Does It Feel Like?
Plantar fascia ruptures are very painful. Many people say that they felt a “pop in my arch” or a “pop in my heel” and then could not place any weight on the foot due to the pain.
What is the Treatment of a Rupture of the Plantar Fascia?
If you suspect a plantar fascia rupture, see a podiatrist immediately. Do not try to treat this yourself. If you are in the Seattle area, contact us for an appointment.
Current recommendations are for patients to be treated for 2 to 3 weeks non-weightbearing using a removable cast boot. During this first two to three weeks you will need to use crutches or a knee scooter. We will usually see you back at that point and, depending on how you are doing, have you start weight-bearing while wearing the cast boot for the next 2 to 3 weeks. We may start you on physical therapy after 3 – 6 weeks. In a 2004 study of athletes suffering from a tear of the plantar fascia, all 18 patients studied returned to activity (which included running, tennis, volleyball and basketball) within 26 weeks, with an average of about 9 weeks.
About the time you start bearing weight, we will talk to you about the use of custom orthotics designed to relieve tension on the plantar fascia. These will help get you back to activity sooner and also help prevent future ruptures. These are the same type of orthotics we use for plantar fasciitis and you can learn about them here.
Treatment Plan Summary:
In the 2004 study, all patients returned to activity after 4 – 26 weeks. 14 of 18 patients returned to activity using custom orthotics to protect the plantar fascia. Mean time to return to activity was 9 weeks.
Week 1 – 3: Non-weightbearing
Week 3: Casted for custom orthotics
Week 3 – 6: Weightbearing in boot
Week 6: Begin weightbearing in shoe with custom orthotic. This orthotic should be a “total contact orthotic” in order to best relieve tension on the plantar fascia.
Causes of Plantar Fascial Rupture
Usually a rupture occurs after some sort of direct trauma to the heel, such as jumping from a height or a sharp blow to the heel or arch. Plantar fascia ruptures, however, do not usually occur all by themselves. There is usually a secondary condition that puts someone at risk for the rupture. Plantar fascia ruptures are more likely to occur in people who have had long-term inflammation in the bottom of their foot (plantar fasciitis). This inflammation weakens the ligament and makes it more prone to rupture. A number of patients who develop a tear in the plantar fascia have had a history of steroid injections for treatment of plantar fasciitis, but it is unclear whether the ruptures are actually due to the steroid or to weakening of the plantar fascia due to plantar fasciitis.
Most patients do very well long term, but you have to be patient. You may not return to your previous activity for up to 7 months. We find that many patients become frustrated and feel that they are not improving because it can take so long to improve. But almost everyone has complete recovery if you give it adequate time. Very rarely, a lump may occur in the plantar fascia at the site of the rupture. This can usually be treated with orthotics, but in extremely rare situations is dealt with surgically.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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