Plantar fascia tears are infrequent but relatively common athletic injuries involving a ligament on the bottom of the foot in the arch, and can cause significant pain and disability in sports and daily activity. It usually is an injury that sidelines most lower level athletes and makes daily walking difficult for non-athletes.
The plantar fascia is a series of three tight rubbery bands that stretches from the heel bone to the ball of the foot. It acts as a stabilizer of the arch as well as tissue that helps contain the vital structures of the bottom of the foot. Strain and damage to this tissue is the most common cause of heel pain and arch soreness, and occurs in many people on a chronic, daily basis. Actual tearing or rupturing of the plantar fascia fibers is a far less frequent injury. It can occur in a chronically strained fascia that simply ruptures out of weakness. More commonly in athletes, it occurs as a direct result of force that drives the front part of the foot up, with the back part of the foot near the arch remaining stable. This results in excessive stretch to the plantar fascia, and the fibers that compose this tissue tear in a partial manner. Stepping on a small blunt object can also sometimes force a rupture of the fascia.
The plantar fascia will not tear all the way across it’s width, as it is composed of several bands. However, a tear can form lengthwise that runs along the distance of the arch.
Symptoms include a sudden popping or snapping sensation in the bottom of the arch, or a sensation that something there ‘gave’. It is followed by significant pain in the heel or arch, and swelling and bruising may also be seen. Simple pressure into the arch may produce excessive pain, as does simple standing and walking.
Treatment of plantar fascia ruptures essentially involves rest, icing, and immobilization of the foot in a walking boot or less commonly in a cast with crutches. As the fascia tear heals over the course of a month, it may require further treatment to improve its tissue integrity and flexibility, including physical therapy. Orthotic shoe inserts are of great importance to keep the fascia stable after the tear has healed, and help prevent re-injury. High level athletes may be able to advance their recovery with concentrated taping and continuous therapy programs, but most people will need about 4-6 weeks to recover from this injury. In some cases, pain can persist in the form of chronic plantar fasciitis, and require a different kind of treatment in the long term to relieve pain. Finally, surgery may be needed in rare cases that do not respond to any other kind of treatment.
Scott R. Kilberg DPM 