Plantar fasciitis is the most common cause of heel pain — inflammation of the fibrous band (the plantar fascia) connecting the heel to the toes, leading to heel pain and difficulty running. Sometimes the plantar fascia ruptures. So 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 to the toes. It’s made up of a large central band and a smaller lateral band. Swelling and tears usually occur where the plantar fascia attaches close to the heel.
Plantar fascia tear symptoms
Most people describe a sudden, severe pain — like a rip — at the heel while jumping or playing sport. Weight-bearing is usually difficult afterwards, and people often find it easier to walk on tiptoes.
There’s often a history of heel pain or plantar fasciitis. Sometimes, plantar fascia treatments that increase the risk of rupture — such as a cortisone injection — have been performed.
On examination, there’s often significant swelling and sometimes bruising at the heel, and the inside of the heel is usually tender to touch. Your doctor also assesses whether the medial arch has collapsed — a sign of a complete rupture.
Plantar fascia tear vs plantar fasciitis
These two conditions are usually relatively easy to tell apart. People with plantar fasciitis describe heel pain in the morning and at the start of activity, which warms up with exercise, only to worsen afterwards. A plantar fascia tear, by contrast, comes on suddenly — a distinct rip during activity, with immediate difficulty bearing weight.
How is a plantar fascia tear diagnosed?
Imaging helps diagnose a rupture and exclude other causes of sudden heel pain, such as a heel fracture or calcaneal stress fracture.
Ultrasound
Ultrasound typically shows thickening of the plantar fascia at the heel attachment, consistent with longstanding plantar fasciitis, along with local areas of fibre disruption, separation, and bleeding-related swelling between the fibres. Stretching the heel during the scan can reveal the fibres separating, confirming a tear.
Plantar fascia rupture on MRI
MRI typically shows thickening of the plantar fascia, consistent with plantar fasciitis. On some specialised sequences, though, an intense bright signal indicates a tear rather than fasciitis. This bright signal also extends into the heel and soft tissues, consistent with bleeding and swelling.
Plantar fascia tear treatment
We start by immobilising the rupture in a walking boot, sometimes with 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 about three weeks, then transitioned from a walking boot to a shoe over another three weeks.
Simple anti-inflammatory measures — regular ice and oral NSAIDs such as ibuprofen — reduce swelling in the early stages. Physiotherapy for gentle mobility and strengthening of the ankle and small foot muscles helps accelerate recovery. As the heel pain settles, you gradually transition from the boot to a shoe. Custom orthotics support the medial arch and relieve tension on the plantar fascia.
As a rule of thumb, avoid cortisone injections for a partial or complete plantar fascia tear, as cortisone is thought to weaken the plantar fascia. Recent evidence suggests PRP can be effective for plantar fasciitis, so it makes sense to consider PRP for a partial plantar fascia tear. We generally use a higher concentration of platelets and white cells for tendon injections such as these.
Plantar fascia rupture recovery time
Frequently asked questions about a plantar fascia rupture
Can you walk with a ruptured plantar fascia?
Yes, but an acute rupture often causes pain and difficulty with weight-bearing. We usually suggest immobilisation in a walking boot for about three weeks, sometimes with crutches early on.
How long does a plantar fascia tear take to heal?
Recovery varies. In the athlete study above, the average return to activity was around nine weeks, with everyone back by 26 weeks. Sticking with the boot-then-shoe progression and rehab gives the best chance of a smooth recovery.
How do I tell a plantar fascia tear from plantar fasciitis?
A tear comes on suddenly — a distinct rip during activity, with immediate difficulty weight-bearing and often bruising. Plantar fasciitis builds up gradually, with first-step morning pain that eases with warming up. Ultrasound or MRI confirms which it is.
How do you treat a partial tear of the plantar fascia?
Similar to a complete tear — immobilisation in a boot, then a transition to a shoe, with orthotics to reduce load on the tear. A PRP injection (with a higher platelet and white-cell concentration) is an option, whereas cortisone is avoided.
Does a cortisone injection for plantar fasciitis increase the risk of rupture?
We think so — studies suggest cortisone injections are a risk factor for plantar fascia tears. So we recommend avoiding cortisone unless other treatments (stretching, strengthening, orthotics, and shockwave therapy) have been tried first, and we favour PRP for fasciitis and partial tears.
Do you need surgery for a plantar fascia tear?
Rarely. Most plantar fascia tears — partial or complete — settle with immobilisation, rehabilitation, and time. Surgery isn’t usually needed.
Final word from Sport Doctor London about a plantar fascia tear
A plantar fascia tear is an acute, painful injury, distinct from the more common plantar fasciitis. Most cases recover well with a period in a walking boot, a graded transition back to shoes, rehabilitation, and — where an injection is needed — PRP rather than cortisone. An accurate diagnosis is the key first step.
If you have sudden or severe heel pain, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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