Plantar fasciitis is the most common cause of heel pain. Inflammation of the fibrous band, called the plantar fascia, connecting the heel to the toes leads to heel pain and difficulty running. Sometimes, the plantar fascia rips leading to a rupture. What is a plantar fascia tear, and how do we treat it?
What is the plantar fascia?
The plantar fascia is a thick fibrous band passing along the underside of the foot connecting the heel with the toes. It is composed of a large central and a smaller lateral band. Generally, we see swelling and tears where the plantar fascia attaches close to the heel.
Plantar fascia tear symptoms
Plantar fascia tear symptoms
In most cases, people describe a sudden severe pain – like a rip- at the heel while performing jumping or sport. Ususally, weight bearing is difficult, and people often find it easier to walk on tip-toes.
Often, there is a history of heel pain or plantar fasciitis. Sometimes, plantar fascia treatments have been performed, which increase the risk of rupture – such as a cortisone injection.
When a doctor examines you, there is often significant swelling and sometimes bruising at the heel. In addition, the inside of the heel is usually tender to the touch. Your doctor will also assess whether your medial arch has collapsed – a sign of a complete rupture.
Plantar fascia tear vs plantar fasciitis
Ususally, we find it relatively easy to differentiate these two conditions.
Overall, people with plantar fasciitis describe heel pain in the morning and at the start of the activity. The pain usually warms up with exercise, only to get worse after.
Investigations
Imaging helps diagnose a rupture and exclude other causes of sudden heel pain, such as a heel fracture or calcaneal stress fracture.
Ultrasound
Generally, we see thickening of the plantar fascia at the attachment to the heel consistent with longstanding plantar fasciitis. In addition, there are local areas of fibre disruption with separation and swelling between the fibres from bleeding. Sometimes, when we stretch the heel, we see the separation of the plantar fascia fibres on ultrasound, confirming a tear.
Plantar fascia rupture MRI
Ususally, MRI shows thickening of the plantar fascia similar to plantar fasciitis. However, on some of the more specialised MRI sequences, we see an intense bright signal indicative of a tear rather than plantar fasciitis. This bright signal also spreads to the heel and soft tissues reflecting bleeding and swelling in the soft tissue.
Plantar fascia tear treatment
Generally, we start with immobilising the plantar fascia rupture in a walking boot. We sometimes suggest crutches if the pain is acute. A recent review of plantar fascia rupture treatment found that most practitioners immobilised patients in a walking boot for three weeks. After that, people transitioned from a walking boot to a shoe over another three weeks.
Simple anti-inflammatory treatments, such as regular ice and oral NSAIDs (such as ibuprofen), effectively reduce swelling in the initial stages. Physical therapy to start gentle mobility and strengthening of the ankle and small muscles of the foot helps accelerate recovery. As your heel pain settles, you should gradually transition from a walking boot to a shoe. Custom orthotics can support the medial arch and relieve tension on the plantar fascia.
As a rule of thumb, you should avoid cortisone injections for a partial or complete plantar fascia tear, as we think cortisone weakens the plantar fascia. Recent evidence suggests that PRP could be effective for plantar fasciitis. Therefore, it makes sense to use PRP for a plantar fascia partial. Generally, we recommend a higher concentration of platelets and white cells for tendon injections like plantar fasciitis.
Plantar fascia rupture recovery time
In a 2004 study of athletes (which included running, tennis, volleyball and basketball) with a plantar fascia tear, the average time to return to activity was nine weeks, with all athletes returning to activity by 26 weeks. So, although the outlook is positive, some cases will take longer to heal than expected.
Other commonly asked questions about plantar fascia rupture:
Can you walk with a ruptured plantar fascia?
Yes, but an acute rupture often causes pain and difficulty weight bearing. Generally, we suggest immobilisation in a walking boot for about three weeks.
Partial tear of the plantar fascia: How do you treat it?
We treat partial tears similarly to complete tears. Generally, we start with immobilisation in a boot, then transition to a shoe. Orthotics are used to reduce the load on the partial tear.
Does a cortisone injection for plantar fasciitis increase the risk of plantar fascia rupture?
We think so. Studies on plantar fascia tears suggest that cortisone injections are a risk factor. Therefore, we recommend avoiding cortisone injections unless you’ve tried other treatments such as stretching, strengthening, orthotics and shockwave therapy. For plantar fasciitis and partial tears, we suggest a PRP injection using a higher concentration of platelets and a high white cell count.
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