Some of the most frequent foot injuries I see involve the heel and arch. A number of different injures can cause pain in this part of the foot, including muscle and tendon strains. However, one structure by far sees the most number of injuries in this region: the plantar fascia. The plantar fascia is a stout ligament that runs along the bottom of the foot Typically it is injured over time, often as a result of strain and inflammation to the fibers from abnormal foot structure, poorly supportive shoes, or repetitive activities like climbing up and down ladders. This type of pain has a more gradual onset, and is known as plantar fasciitis. However, when the pain is sudden, and accompanied by a mis-step as well as a tearing or snapping sensation, the injury is often more severe, and involves a partial tearing of the fascia. As fasciitis and a tear are treated quite differently, prompt diagnosis and proper treatment can make the difference between a relatively short recovery period and a prolonged done.
The plantar fascia tear, or rupture as it is commonly known, can occur when a foot is planted on the ground firmly at the base of the toes, causing a sudden stretching of the plantar fascia beyond its limit to stretch. This can also occur when the foot is suddenly flexed upward by force, or when stepping on an object like a root or the broad edge of a rock while barefoot or in poorly supportive shoes or sandals, in which a specific part of the fascia is forced upward suddenly. The symptoms can include a sudden sharp or burning sensation, accompanied by a sensation of tearing or snapping. For most, it is extremely difficult to bear weight. The fascia tissue usually only tears partially, with most of its substance remaining intact. However, this smaller part that is torn can create a significant amount of pain. Often felt in a specific location in the arch or heel, the pain can eventually expand to include a broader area.
Treatment of plantar fascia tears requires immediate immobilization of the foot to reduce forces that load onto the plantar fascia when walking, and permit the tissue to heal. The mainstay of my treatment includes the use of a pneumatic walking boot to displace the forces of walking, as the shape of the bottom of the boot is that of a rigid rocker bottom design, which helps the foot roll over the ground without bending. Severe cases of plantar fascia tears do require further immobilization in a below knee cast and non- weight bearing, although most people do just fine in the walking boot. It is typical for the fascia to take four weeks to heal, although some people can have prolonged discomfort for another month or two. If this injury is not treated and left to heal on its own, the time for healing could extend into months and years, as the development of inflammatory plantar fasciitis becomes inevitable at that point.
If you suddenly feel pain in the heel or arch after stepping oddly (especially with a tearing or snapping sensation), and the pain does not go away within a day or two, it is a good idea to see your local foot specialist for immediate care (or see me if you are in the central Indiana region). This could make the difference between a quick recovery and a protracted one.
Scott R. Kilberg DPM 