Acute plantar fascia ruptures occur during sudden trauma, such as falling or jumping from a height. Runners, basketball players, and football players may also experience this type of injury. Patients often describe a “pop” or bruising in their heels, and report pain and swelling, which are more prevalent in the morning. Conservative treatment is usually effective in reducing pain and allowing the patient to return to normal activity gradually.
While it can take several months for the condition to resolve, treatment options depend on the type of rupture. Initial treatment is focused on pain control. Weight bearing may be allowed after four to 10 days, and patients may be prescribed stiff-soled comfort shoes instead of a protective walker boot. Gentle plantar stretching may be prescribed to ease the symptoms, and non-steroidal anti-inflammatory drugs are used to reduce inflammation and alleviate pain. Patients can then begin a return to weight-bearing activities, such as walking, running, or jumping. The average recovery time is nine weeks, however, and a full recovery can take months.
MRIs are an important diagnostic tool. Imaging studies reveal abnormalities in the plantar fascia, which include calcaneal attachment and rupture. In most cases, plantar fibromatosis does not involve the calcaneal attachment. Transverse and sagittal images can demonstrate the anatomic course of the rupture. Oblique images are also useful for evaluating the lateral component of the plantar fascia.
Patients with a plantar fascia tear usually experience a burning sensation in their arch and heel, which may be accompanied by bruising. They may also experience a painful lump. This condition may also result in difficulty walking. A doctor will use diagnostic ultrasound and MRI tests to confirm a diagnosis. Treatment can include R.I.C.E. to reduce swelling and inflammation and may require immobilization of the foot or ankle to heal properly.
MRI is the most sensitive imaging technique for identifying fascial ruptures. MRI allows doctors to determine the exact location and extent of the rupture. MRI also reveals the attachment of the plantar fascia and its course. Scanning the fascia with MRI demonstrates the medial and lateral band and the attachment of the fascia. MRIs of the plantar fascia are best used to visualize the rupture and its impact on the foot.
A male athlete presented to the emergency department with symptoms of acute right-foot pain. He was unable to perform any weight-bearing activities on the affected foot. MRI revealed edema of the surrounding tissues and a ruptured plantar fascia. The patient was prescribed an anti-inflammatory and partial-weight-bearing cast-boot for 3 weeks. At 8 weeks post-injury, he was able to return to active sports.
The primary diagnosis of torn plantar fascia may be made with a thorough physical examination and history of the patient’s history. X-rays may be necessary to rule out other conditions. Physical therapy can be a valuable treatment option, focusing on histopathologic changes. Using the Graston Technique, physical therapists can restore normal mobility to the inflamed tissue. There are many treatments available for this painful condition.
MR imaging is a crucial tool for diagnosing PA ruptures. The imaging allows for the precise localization of the lesion and its severity. It also helps differentiate between long-standing and recent ruptures. The use of this tool also clarifies what type of treatment is necessary. Conservative treatment may include anti-inflammatory medications and physical activity restrictions. If conservative treatment does not alleviate symptoms, surgery may be necessary to release the PA.
Injections have proven helpful in many cases of plantar fasciitis, and corticosteroid injections have been widely recommended. However, corticosteroid injections may weaken the plantar fascia. Several studies show that corticosteroid injections are safe and effective. A patient will experience sudden pain, especially on the calcaneal insertion. The pain associated with the rupture may be more pronounced in the calf than in the heel.
A medical history and physical examination will help determine whether plantar fasciitis is the cause of the pain. In addition to a physical exam, an X-ray or MRI may be needed to rule out a stress fracture or a bone spur. Though once thought to be the cause of heel pain, bone spurs have become common as well. If you experience any of these symptoms, you should see a healthcare provider as soon as possible.
