Does a full or partial plantar fascia rupture increase your risk of a plantar fascia tear later? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question posted in the comments section of one of the Doc On The Run YouTube channel videos. Specifically, it came after a viewer watched the video entitled Top Three Clues of a Plantar Fascia Rupture and Davis posted a question. He wanted to know, does a full or partial plantar fascia rupture greatly increase your risk for a re-tear.
Well, that is a good question. So, the interesting thing is that if you take his question and you put it in a MEDLINE search to look through existing articles, studies that have been published in medical journals worldwide, you find nothing. In fact, when I searched for the terms plantar fascia, re-rupture and rate, all of the 76 studies that were published there did not say anything about the plantar fascia at all and almost all of them referenced injuries, ruptures and re-ruptures to Achilles tendon tears and many cases after surgical repair. I was talking about re-rupture, about the Achilles.
Well, the Achilles tendon is not the same as the plantar fascia ligament. A ligament connects two bones. A tendon connects muscle to bone and the Achilles tendon is the largest tendon in your body and it is also the one that gets ruptured the most. So, it’s not the same and you can’t really compare apples and oranges.
I did a little deeper digging, and I actually found a study published in 2022, fairly recently and it said due to the scarcity of evidence reporting on adverse events, it is also not possible to make confident conclusions regarding the safety of plantar fascia surgical interventions. And what this study was talking about was about the efficacy or the effectiveness or the safety, meaning is it going to harm you later if you have surgery for plantar fasciitis like an actual surgical tear where we cut the plantar fascia.
I have done this a bunch of times. This is an endoscopic plantar fascia release. We go and we cut the ligament, we decrease the tension on the fascia and we get rid of your heel pain that way. Now, having said that, I’ve not done that on a runner in a very, very, very long time, way more than a decade because I don’t think it’s a good idea. Again, there isn’t much evidence that shows like, there are no studies by the way in runners saying like if you’re a runner and you have an endoscopic plantar fascia release surgery, which is basically a surgically induced tear, are you at greater risk for re-rupture? But stop and think about this question from Davis.
If you have a ligament that is intact, you have highly organized collagen, all in perfect alignment, linear collagen, it’s all structurally sound. If you cut it and then it gets scar tissue that is disorganized, it’s not perfectly linear, it’s not as well organized, do you think it’s going to be stronger or weaker? Do you really need to be a surgeon to answer that question? Do you really even need to read an article that tells you yes or no? It just stands to reason that there’s no way it could be as strong.
Is it higher rate of re-rupture? Well, that depends. The idea with the surgical release is we cut part of it and it forms a gap. It now has less tension. If it fills in with scar tissue, even though it’s not as strong, it does have less tension on it and so it might not re-rupture just because it has less tension, but your foot is a structural thing. Your ligament helps maintain the structure of your foot, the architecture of your foot. It’s stabilizing it.
If you’re pulling on it so much that it rips, what is going to happen to that stress if you stretch it out and you don’t have that stress applied to that ligament? That stress has to go somewhere. It’s going to get applied to other structures. Then you might get a tear in the spring ligament or some other structure in your foot. So, although it’s a great question, whether or not tearing it may put you at risk of a re-rupture, but if it doesn’t put you at risk of a re-rupture or re-tear, it’s going to put you at risk of other problems because that stress has to go someplace.
If you want to learn more about runner’s heel pain, I go into a deep dive in the strategies that I use with runners who have heel pain, like plantar fasciitis, plantar fasciosis, partial tears, calcaneal stress fractures, all that stuff. You can come join me and get it for free at www.docontherun.com/heelpainmasterclass. So, come check it out and I’ll see you in the training.
Reference:
C. Sian MacRae, Andrew J. Roche, Tim J. Sinnett, Neil E. O’Connell. What is the evidence for efficacy, effectiveness and safety of surgical interventions for plantar fasciopathy? A systematic review. PLoS One. 2022; 17(5): e0268512. Published online 2022 May 18. doi: 10.1371/journal.pone.0268512
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