Originally Posted by nevparker

Colleagues,

I regularly dip in to Podiatry Areana and wanted to find out if we have a recognised treatment pathway for rupture of the plantar fascia. PF has numerous clinical guidelines linked to it and they all suggest the negative mechanical effects of Fasciotomy surgery. When this is unavoidable in the case of traumatic PF rupture, what would be recommend for treatment.

I had a patient present recently with traumatic pain at the insertion with severe discomfort along the course of the structure distally (with and without tension, but worse with tension). The give away factor was the acute swelling and bruising plantarly and in the area of the spring ligament. Interestingly the patient has cavoid feet and doesn't fit the pes planus plastic deformation model.

R.I.C.E was initiated and some low dye strapping for a few days. As the area was vary painful a soft orthosis was used with increased arch support. The patient has been unwilling to rest the foot so I have been unable to immobilise the structure. He is now 8 weeks post injury and applying mechanical theory, the next move would be to try a rigid orthosis.

I would welcome your thoughts on a standard treatment protocol and recommendations for future management of my patient.

Thanks

Neville

Originally Posted by nevparker

Colleagues,

I regularly dip in to Podiatry Areana and wanted to find out if we have a recognised treatment pathway for rupture of the plantar fascia. PF has numerous clinical guidelines linked to it and they all suggest the negative mechanical effects of Fasciotomy surgery. When this is unavoidable in the case of traumatic PF rupture, what would be recommend for treatment.

I had a patient present recently with traumatic pain at the insertion with severe discomfort along the course of the structure distally (with and without tension, but worse with tension). The give away factor was the acute swelling and bruising plantarly and in the area of the spring ligament. Interestingly the patient has cavoid feet and doesn't fit the pes planus plastic deformation model.

R.I.C.E was initiated and some low dye strapping for a few days. As the area was vary painful a soft orthosis was used with increased arch support. The patient has been unwilling to rest the foot so I have been unable to immobilise the structure. He is now 8 weeks post injury and applying mechanical theory, the next move would be to try a rigid orthosis.

I would welcome your thoughts on a standard treatment protocol and recommendations for future management of my patient.

Thanks

Neville

Originally Posted by barry hawes

Hi all,

I agee with LL's suggested protocol for management of PF rupture, perhaps with the addition that, in severe cases, non-weight bearing with crutches + compression for the first few days may be more comfortable for the patient. I've seen quite a few of these over the years and some are too painful on weight bearing even in Aircast in the initial stages. Nearly all the cases I've seen have been acute-on-chronic presentation with a history of plantar fasciitis/fasciosis preceding rupture, sometimes following cortisone injection. (This history is well supported in the reported cases in "the literature")

With regard to Mart's question, I suppose PF rupture may or may not involve some of the intrinsic musculature mentioned. Clinical test to differentiate may include contraction against resistance. I suppose the next question would be whether this would change treatment protocol.

Cheers,

Barry Hawes

Originally Posted by barry hawes

Hi Mart,

My previous posting may have been ambiguous. My experience, supported by the reported cases of PF rupture, has been that rupture occurs following chronic plantar fasciitis/osis. Only some of the cases I have seen (and those reported) have been subject to cortisone injection. I make no assumption about the causal relationship between injection and rupture, but strongly suspect there is an assocition with pre-existing plantar fasciitis and rupture.

It's been a few years since I searched the literature on this subject, but here are few references;

1)Herrick and Herrick; Rupture of the plantar fascia in a middle age tennis player, AJSM; 11/2 1983

2)Pai and D'orth; Rupture of the planar fascia; 1996, J Foot and Ankle 35/1; 39-41

3)Leach et al; Rupture of the plantar fascia in athletes; 1978; J bone and Joint Surgery; 60/4; 537-539

4) Ahstrom P; Spontaneous rupture of the plantar fascia; 1988; AJSM; 16/3; 306-307

5) McElgun T and Cavaliere R; Sequential rupture of the plantar fascia in a tennis player; 1994; JAPMA; 84/3; 137-140

6) Rolf C et al; Plantar Fascia Rupture: diagnosis and treatment; 1997; J Foot and ankle surgery; 36/2; 112-114

7)Lun V et al; Spontaneous rupture of the plantar fascia; 1999; Clin J Sport Med; 9/1; 48-49

........and if your French is up to it (I include this because it's the largest series of case studies I've seen);

8)Poux D et al; Les Rupture de l'aponevrose plantaire; 1989; J Traumatol. Sport;(6) 77-87

A couple of again older, but interesting, papers which look at the association between corticosteroid injection and plantar fascia rupture;

9) Acevedo and Beskin; Complications of Plantar fascia rupture associated with corticosteroid injection 1998; Foot and Ankle 19/2; 91 - 97

10) Sellman J; Plantar Fascia Rupture Associated with Corticosteroid injection 1994; Foot and Ankle 15/7; 376 - 381.

For me the most important implication of any association between rupture and pre-existing plantar fasciitis is in the advice I give patients who are having treatment for the latter and want to return to sports involving ballistic activity (i.e. "hasten slowly")

Cheers,

Barry Hawes

Originally Posted by Mart

These seem to be most common cited papers for corticosteroid injection risk. Anyone can post or add to them?


Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1994; 15(7):376-81.

Leach R, Jones R, Silva T. Rupture of the plantar fascia in athletes. J Bone Joint Surg Am 1978; 60(4):537–539.

cheers

Martin

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