Plantar Fascia Rupture

in Plantar Fasciitis

Ho Seong Lee · Jae Jung Jeong*

Department of Orthopaedic Surgery,

Asan Medial Center, Ulsan University, seoul, Korea

* The Catholic University of Korea, Daejeon St. Mary’s Hospital

Plantar Fascia Rupture in Plantar Fasciitis

Ho Seong Lee · Jae Jung Jeong

My disclosure is in the

Final AOFAS Mobile App.

I have no potential conflicts with

this presentation.

Rupture of Plantar Fascia

• 1st report of plantar fascia rupture in athletes

Leach R, JBJS(Am), 1978

• Considered as acute injury occurred in athletes

• Plantar fascia ruptures have recently been reported

in the setting of preexisting plantar fasciitis

- Spontaneous rupture in old age Pai V, J F&A Surg, 1996

- Plantar fascia rupture after plantar fasciitis

Acevedo J, FAI, 1998

Rupture of Plantar Fascia

<New problems>

• lateral foot pain

: weakened medial arch, compressive force on lateral side

• poor definited mid-foot pain & weakness

: longitudinal arch strain, lateral & dorsal mid-foot strain

• lateral plantar nerve dysfunction

: d/t loss of arch support resulting in hyperpronation

• Metatarsal stress fracture

• Hammer toe deformity

d/t inefficiency of the intrinsic flexor & plantar aponeurosis

• Swelling & antalgia (Acevedo, FAI, 1998)

Purpose

• To analyze risk factors causing plantar fascia rupture

in preexisting plantar fasciitis

Material

• Mar. 2004 – Feb. 2008

• Retrospectively reviewed 286 patients with

plantar fasciitis who were referred from private clinics

METHOD

• Patients were divided into patients with or without a

plantar fascia rupture

• There were 35 patients in the rupture group and 251 in

the non-rupture group

• We compared age, gender, the affected site, the VAS

score, previous treatment regimen, body mass index,

degree of ankle dorsiflexion, the use of steroid

injections, the extent of activity, calcaneal pitch angle,

the presence of a calcaneal spur, and heel alignment

between the two groups.

Diagnosis of rupture

• Plantar fascia rupture with preexisting plantar

fasciitis was diagnosed in 2 steps

• palpating the continuity & tension of the plantar

fascia during passive DF of Ankle and MTP joint.

comparing with contra-lateral side

• The plantar fascia rupture was confirmed by

ultrasonography or MRI

RESULTS

Plantar fasciitis (286 patients)

Total With rupture Without rupture

P-value

Patients (N) 286 35 (12.2%) 251 (87.8%)

Age 54.8 58.5 54.4 0.168

Gender Male 105 12 93

0.852 Female 181 23 158

Foot(N)

Right 111 15 96

0.770 Left 121 20 102

Bilateral 53 0 53

RESULTS

With rupture

(n=35)

Without rupture

(n=251) P-value

VAS 5.6 6.0 0.266

BMI (kg/m2) 25.0 25.2 0.780

Steroid injection 33 (94.3%) 62 (24.7%) <0.001

Ankle dorsi flexion 15 16.1 0.332

Activity Highly 17 110

0.717 Daily 18 141

Calcaneal pitch angle 14.3 15.1 0.223

Calcaneal spur 15 120 0.594

Heel

alignment

Varus 3 16

0.261 Normal 27 218

Valgus 5 17

Associated

disease

DM 8 42 0.478

HT 8 49 0.653

Thyroid 3 13 0.426

RESULTS

Logistic regression analysis

Risk Factor Odd ration (95% CI) P-value

Age 1.048 0.283

BMI 0.611 0.680

Ankle DF 1.913 0.129

Actvity 0.364 0.619

Steroid injection 34.437 <0.001

Calcaneal pitch 0.966 0.539

DM 0.586 0.215

DISCUSSION

• 37 plantar fascia rupture treated for plantar fasciitis

all patients were found to take a steroid therapy

Sellman, FAI, 1994

• Spontaneous rupture in elderly patients

Pai, J F&A Surg, 1996

• 44 of 51 cases of rupture

following the steroid injection

Acevedo, FAI, 1998

SUMMARY

• Acute traumatic rupture 2/35 (6%),

• Chronic rupture after plantar fasciitis 33/35 (94%)

• Chronic rupture in 12% of plantar fasciitis pts

• Extra-subcalcaneal pain in 50% of rupture pts

• 33/35 chronic rupture : history of steroid injection

• No correlation

- Ankle ROM, BMI, activity, associated disease

- Radiologic findings: heel alignment & calcaneal spur

CONCLUSION

Chronic plantar fascia rupture after plantar fasciitis

The greatest risk factor for a chronic plantar

fascia rupture was steroid injection

Steroid injection for plantar fasciitis should be used

cautiously because of the risk of plantar fascia rupture

Plantar Fascia Rupture

References

1. Acevedo, J: Beskin, J: Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 19:91-97, 1998.

2. Balasubramania, P; Prathap, K: The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg Br. 54-B:729-734, 1972.

3. Buchbinder, R: Plantar Fasciitis. N Engl J Med. 350:2159-66, 2004.

4. Coughlin, MJ; Mann, R; Saltzman, CL: Surgery of the foot and ankle. Vol. 1. 8th ed. Mosby Inc, Philadelphia, pp 689-705, 2007.

5. Leach, R; Jones, R; Silva, T: Rupture of the plantar fascia in athletes. J Bone Joint Surg Am. 60-A:537-539, 1978.

6. League, AC: Current Concepts Review: Plantar fasciitis. Foot Ankle Int. 29:358-366, 2008.

7. Pai, V: Rupture of the Plantar Fascia. J Foot Ankle Surg. 35:39-40, 1996.

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12. Sellman, JR: Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 15:376-381, 1994.

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14. Wearing, SC; Smeathers, JE; Urry, SR; Hennig, EM; Hills, AP: The pathomechanics of plantar fasciitis. Sports Med. 36: 585-611, 2007.