Plantar Fascia Rupture - DOC

Plantar Fascia Rupture

A ruptured plantar fascia is a very painful tear in the largest ligament in the foot (the plantar fascia). It often mimics the most common type of heel pain called plantar fasciitis. Cortisone heel spur injections (steroid shots intended to treat heel pain) can put you at risk for a rupture of the plantar fascia. This painful condition causes arch pain, heel pain, and sometimes swelling or bruising in the bottom of the foot. It will not usually get better on its own.


What is a Rupture of the Plantar Fascia?

The plantar fascia is a very large fan shaped ligament that covers the muscles and other structure in the bottom (plantar surface) of the foot. A rupture is just a rip or tear in a tendon or ligament. So a ruptured plantar fascia is really just a painful, tear in the largest ligament in the foot. Most people who have this suffer from arch pain, heel pain, and sometimes swelling or bruising in the bottom of the foot. It often mimics the most common type of foot pain called plantar fasciitis.


What Causes a Rupture of the Plantar Fascia?

The plantar fascia can be injured or torn from direct trauma such as a sharp blow to the bottom of the foot, arch or heel. Jumping or falling from a height can also stress the ligament to the point of tearing. It is also possible that running (particularly sprinting) could place enough strain on the ligament to cause it to tear.

But plantar fascia ruptures are rare by themselves. There is often there is an associated condition that puts someone at risk. Some medications can increase the risk of tendon and ligament ruptures.  If you are have been recently taking steroids (prednisone) or flouroquinalone antibiotics (Cipro, Levaquin, etc.) you could be at risk for one of these ligament ruptures. You may have seen in the news where the FDA recently posted a strong “Black Box” warning about these antibiotics and the associated risk of tendon ruptures.


Symptoms of Plantar Fascia Rupture

You might have a rupture of the plantar fascia if you have any of theses signs and symptoms:          

• Pain in the heel or arch          

• Pain gets worse as with activity (walking, running, or standing)         

• You find it hard to participate in some activities (such as running, walking and standing on the toes)      

• Pain in the bottom of the foot, heel or arch, even at rest         

• You noticed swelling or bruising in the arch or heel         

• A tender spot or lump between the arch and heel         

• You were told you have plantar fasciitis but it isn’t getting better         

• You had multiple heel spur injections right where it hurts now         

• You felt a sudden sharp pain when this all started         

• You heard or felt a “pop” in the arch when this all started          

• Limping or changes in the way that you walk         

• You think that your arch might be collapsing


Diagnosis of Plantar Fascia Rupture

When you suspect you have a rupture of the plantar fascia, your foot doctor will begin by taking a complete history of the condition to make sure that he has the full story. A physical exam will also be performed. X-rays are usually performed on the first visit as well to look for any change in joint alignment or possible fractures that can mimic the pain of a ruptured plantar fascia.  The history, exam and x-rays may sufficient for your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound or MRI to further evaluate the plantar fascia.  A torn plantar fascia will show up on these tests, but the MRI is often more reliable.  The results of these tests can usually be explained on the first visit. In this way,  you can get a full understand of how the rupture started, what you can do to treat prevent it from getting worse, and which treatments will be most helpful in healing the injured ligament.  


Treatment of Plantar Fascia Rupture

In general, the treatment for a true rupture of the plantar fascia is immobilization.  This can be accomplished with either a cast or a walking boot. The cast provided the most reliable form of immobilization, but makes it hard to bathe and change clothes. A fracture walking boot can be as effective as a cast if your consistently. Sometimes crutches are required to decrease the pain in the heel and arch, and let the rupture heal.  Physical therapy and custom orthotics can also help a great deal once the ligament healing starts to take place. 

Steroids and Cortisone are very effective at decreasing pain and inflammation. But when you have a rupture in the plantar fascia, cortisone injections can actually delay ligament healing, break up collagen bonds that from the plantar fascia fibers, and even make the tear bigger and much worse. In most cases, it is best to avoid steroids with these injuries. 

Anti-inflammatory Medications (such as ibuprofen, naproxen and other NSAIDs) can make the heel and arch feel better. However, studies have shown that these drugs can also inhibit the ligement healing process that needs to take place.    

Pain Relievers (such as Tylenol and narcotic pain medicines) can make the heel and arch feel much better without interfering with the healing process. Having said that, it is important that you don’t let pain medicine mask the pain and walk on the foot.  This can cause more damage and further injury.  

Platelet Therapy Injection involve a relative new “biologic” treatment. This is also referred to as “Platelet Rich Plasma (PRP) Injections” or “Autologous Platelet Concentrate (APC) Therapy.” This advanced treatment involves the injection of your body’s own concentrated healing factors right into the area of injury.  These injections have a great deal of promise for speeding healing of injuries that have not gotten better with other treatments. This is a very new treatment and it is not offered in all doctors offices. This is one of the treatments we offer to help get you better as quickly as possible.                   


Surgery for a Rupture of the Plantar Fascia?

Fortunately, surgery to directly the repair the plantar fascia is rarely needed. Most people with a ruptured plantar fascia injury will get better without surgery.  The only exception to this is in cases that are chronic in nature and have been neglected. If the tear is large enough, the arch can collapse an lead to flat foot deformity, and other problems.  These other problems can lead to reconstructive foot surgery later on.  

Is Plantar Fasciitis the same as a Rupture of the Plantar Fascia?

No. Although the same ligament (plantar fascia) in the foot is involved in both, they are very different problems.  One is just inflammation of the ligament while the other is an actual torn ligament.  Because they are different problems, they have to be treated differently to get better.  For example, steroid injection can help heal plantar fasciitis, but steroids can prevent healing in a plantar fascia rupture and even make it much, much worse.   


When to see a Foot Specialist for a Rupture of the Plantar Fascia?

Any time you have pain, redness or swelling and especially bruising in the heel or arch, you should consider this a medical emergency.  You must seek help right away. Heel and arch pain associated with these injuries is very painful and that alone is reason enough to get help. But even more concerning is that the tear can get worse and lead to serious problems later on.   Because a rupture in the plantar fascia can also look like and infection, you should immediately see a foot and ankle specialist if you have any redness or fever associated with the foot pain. If your doctor’s office says they can’t see you right away, call someone else who will see you the same day.  Otherwise, call 911 or head to the emergency room.  Whatever you do, don’t wait.