Today on the Doc On The Run Podcast, we’re talking about the standard routine for healing a partial tear of the plantar fascia in a runner.
Today’s episode comes from a question who was sent in by a runner who wrote in and said,
“I’m struggling with a partial tear going on six months of pain with running. I’ve tried everything, physical therapy, rest, PRP, and recently embryonic membrane injections. This injection was four weeks ago, with crutches for five days after and a boot for two weeks. I’ve also had four weeks of no running at all and still have the pain.
I would love to know what your ‘standard routine’ is for this condition. Is there a way I can find out that information?”
This is a great question and thanks for sending it in!
Everyone wants to know a standard routine for healing…including physicians, not surprisingly.
When I lecture at medical conferences on runner’s heel pain, that’s one of the questions I often regarding plantar fasciitis, with a stress fracture in the heel bone and with partial ruptures of the plantar fascia…doctors want to know what I do with runners to help them actually heal in a consistent fashion.
There are a couple of reasons why that is a very difficult question to answer.
I don’t really believe there’s a standard routine because all runners are different.
Obviously, the person who sent in this question has had a lot of trouble and hasn’t been running for six months.
But there are a couple of things to really think about when you’re trying to figure out what is best for you, if you have a partial rupture of the plantar fascia.
I recently gave a lecture at the International Foot & Ankle Foundation meeting in Hawaii.
One of the lectures I gave at that medical conference was called “How the Standard of Care Fails Athletes.”
In that lecture I specifically talk about how it is that routines, standard protocols and some standard set of instructions for patients does not really work well for athletes.
Yet there are couple of things to really think about that may help you get on track, however.
The first thing is that all partial ruptures are not created equal.
You can get an injury to the plantar fascia called an “interstitial tear.” That is where you basically have a tear that is inside the plantar fascia ligament.
Yes, it is a partial tear, because it’s not completely ripped all the way across the plantar fascia ligament. So technically it is a partial tear, but the tear is actually on the inside of the ligament.
It’s sort of like if you overstretch a rubber band, pull it apart and you hold it up to light and you can see this sort of wavy thing on the inside of the rubber band where the inside of it has actually ripped a little bit. Well, that’s an interstitial tear. Those heal a lot faster because you actually have collagen on all sides of the actual tear sort of supporting and stabilizing it so it can withstand more stress and still heal.
And you can also have a partial rupture or a tear in the plantar fascia ligament that is where it’s full-thickness. It’s ripped all the way through, but it’s only ripped part of the way across. If you think about a rubber band in that scenario and you actually cut the side of the rubber band, that would be analogous to a full-thickness partial tear of the plantar fascia. Now that is going to take a lot longer to heal because the edges get pulled apart every time you stretch the plantar fascia.
But there are really four things that are really keys to healing partial ruptures in the plantar fascia if you’re a runner.
The first thing is that when you have a partial tear in the plantar fascia, you have to realize that number one, it has to heal. If you’re stretching it to the point where it is irritating and moving the rip and it’s making it worse, it’s just not going to heal. So you have to have some period of time where you’re either on crutches or in a fracture walking boot or a cast or whatever, where it will start to heal.
The second thing is that a partial tear of the plantar fascia cannot heal unless it is stable enough for the cells to lay down new collagen without ripping apart those newly formed strands of collagen.
The third thing is that as soon as that collagen repairs starts, you have to remember and realize that the tissue is getting stronger day by day. If it’s getting strong enough to withstand more stress, that means you can do more activity as you continue along that continuum of healing, and increase in strength and stability of the plantar fascia ligament.
And then the fourth thing is to remember that the key is really to match the tissue strength with the activity level.
So when I teach physicians about this, it’s too complicated just to explain in a simple podcast, but there is a way to tell. You basically have to immobilize it. You have to take all the pressure off of it and then you have to very systematically test it to figure out whether or not you’re at that place where you can get rid of the crutches or if you should get rid of the fracture walking boot or if you can start running.
At each stage of healing and recovery, there is a way to figure that out. But it’s stage by stage, runner by runner, and each runner is different.
There is not one period of time, like a certain number of weeks on crutches or a certain number of weeks in the boot that will just work for everybody without completely decimating your fitness.
So it has to be tailored, it has to be individualized, and you and your doctor have to work closely together to figure out when it’s appropriate for you to take that next step in increasing your activity so you can get back to running as quickly as possible.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!