Before describing the condition, you may wish to read about the normal anatomy of the plantar fascia here.

You may also wish to read about plantar fasciitis.

The plantar fascia ligament is a thin band on the sole that has a very important role in the foot, maintaining the shape and arch of the foot.

Plantar fascia tear is when a part or all of the fascia is torn.

MRI of the hindfoot. A – normal thin band of plantar fascia B – thickened and wavy appearance of plantar fascia which has a 50% partial tear

The plantar fascia can be torn acutely in a patient with chronic plantar fasciitis. In this condition the plantar fascia is degenerative and damaged. In the presence of tight calf muscles the frayed and weakened plantar fascia is put under tension and can snap. Patients usually have pre-existing symptoms of plantar fasciitis but occasionally it can be sudden with no prior symptoms.

Patients who have any medical intervention for the treatment of plantar fasciitis are also at risk. Steroids (corticosteroids) can weaken normal tissue particularly ligaments and tendons making it susceptible to rupture. For that reason steroids should never be injected directly into tendons or ligaments. We minimise the risk of this by only performing image guided injections.

Pain is the main symptom.

It is typically very severe, constant in nature and made worse by weight bearing.

Patients often have a marked limp.

Ultrasound

An ultrasound is a quick and pain free investigation that can confirm the diagnosis.

MRI

MRI is particularly useful in making the diagnosis and ruling out other conditions that cause heel pain. It is also requested if there are atypical symptoms and examination findings.

MRI is particularly useful in assessing:

• Thickening of plantar fascia
• Evidence of plantar fascia rupture or tear
• Cartilage damage (arthritis)
• Reactive bone changes (stress response)
• Synovitis (inflammation and fluid in the joint)
• Inflammation and oedema in tissues
• Inflammation of bursa (bursitis)
• Other pathology

MRI of the heel viewed from the front demonstrating injury to the plantar fascia origin

MRI of the hindfoot demonstrating rupture of the plantar fascia

Non-operative management aims at relieving pain ad allowing return to normal function.

It should always be the first line of treatment. Options include:

Activity modification

A period of rest from sports and exercise that bring on symptoms. Avoiding high impact activities and sports. Reducing the amount of time standing and walking particularly on hard surfaces.

Footwear

Wearing shoes with cushioned heels.

Immobilisation and protected weight bearing

Immobilisation in a walking cast or boot for 4 weeks is sometimes indicated and may help alleviate symptoms. Depending on degree of symptoms patients may be advised to non weight bear or partial weight bear.

Non steroidal anti-inflammatories

The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort from the acute inflammation and swelling that results from plantar fascia tear.

Time

It can take up to a year or more for symptoms to settle.

Image guided steroid injection

In very few select cases an image guided local anaesthetic and steroid injection at the plantar fascia origin is performed. This is carried out under a short general anaesthetic and under x-ray control.

This is reserved for patients with severe pain who have failed to respond to conservative measures.

Patients are always immobilised in a walking boot and are usually non weight bearing for several weeks to allow symptoms to settle.

There currently is no operation for acute plantar fascia tear.

Potential complications of non-operative treatment include:

• Worsening pain
• Medial arch collapse and acquired flat foot deformity
• Abnormal gait – altered kinetic chain with resulting problems in ankle, knee, hip or back