Blog | Monday, December 3, 2018

Ruptured plantar fascia


Many people have experienced plantar fasciitis. It is a painful bottom (plantar surface) of the foot that often comes on after athletic exercise, prolonged hiking or running or just for no reason at all.

The plantar fascia is a band of tissue that connects the heel bone to the toes. This wide ligament covers the entire bottom of the foot and acts like an elastic band under the arch and helps absorb shock when you walk. Inflammation and tiny micro tears are the culprit in plantar fasciitis. Most patients can diagnose it themselves and it rarely needs imaging or any special tests.

Ruptured plantar fascia is relatively rare and the snap occurs suddenly, usually with exercise. The force of jumping or stepping can cause a tear that causes sudden pain and inability to bear weight on that foot. The injured athlete often feels a “pop” when the fascia snaps. Within 24 hours the blood from the tear forms a bruise on the bottom of the foot.

So what should be done for a torn plantar fascia? Like any muscular injury, ice is the first treatment. It not only limits further bleeding and swelling, it also provides pain relief. Elevation and compression (ace wrap) are also first treatments. An ultrasound is usually as effective as an MRI for seeing the ligament but the diagnosis does not require any imaging. Physical therapy and using a walking boot are helpful for the first few weeks of healing. It is very rare that surgery is needed. The fascia forms a scar and heals itself. Sometimes shoe orthotics are used to support the arch during healing.

The best way to keep your feet healthy and prevent plantar injuries are:
• weight control,
• never get a steroid injection into the plantar fascia (it is a risk factor for rupture),
• stretching the toes and feet before activity,
• stretch the arch of your feet,
• stretch the Achilles tendon (it's all connected),
• wear good athletic and walking shoes with arch support,
• use heel cups or shoe inserts (over the counter is fine), and
• flex your feet/toes upward when you are in bed and before you get up in the morning.

This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.