The plantar fascia is connective tissue connecting the heel bone (calcaneus) to the toes. Its primary function is to support the arch of the foot during weight-bearing activities. The term “plantar fasciitis” describes the common condition of inflammation and chronic degeneration of this tissue due to overuse and repetitive strain. While this chronic condition is frequently seen, the plantar fascia can sustain a much more severe injury: an acute tear or complete rupture.
Differentiating a Tear from Plantar Fasciitis
Plantar fasciitis and a plantar fascia tear represent two distinct types of injury to the same tissue. Plantar fasciitis is an overuse syndrome, developing gradually as a chronic condition involving microscopic tears and disorganized collagen fibers near the heel insertion. The pain is characteristically worse with the first steps in the morning or after periods of rest, often described as a dull ache or sharp pain that can lessen slightly with movement.
A plantar fascia tear is usually an acute, traumatic event that results in a partial or complete separation of the tissue. This injury often happens during a sudden, forceful movement like sprinting, jumping, or falling from a height, putting extreme, unexpected tension on the foot. A tear may also occur as a complication of long-standing, chronic fasciitis or following a corticosteroid injection, which can weaken the fascia.
The presentation of a tear begins with a sudden, sharp, immediate pain and often a distinct “pop” or tearing sensation felt in the arch or heel. Following the injury, the patient typically experiences significant difficulty bearing weight, along with swelling and bruising visible on the sole of the foot. A partial tear involves damage to only a portion of the fascia, while a complete rupture means the tissue is fully separated.
Recognizing and Diagnosing a Rupture
A plantar fascia rupture is suspected based on a history of sudden, traumatic pain, particularly if a popping sound was heard. Clinical examination may reveal tenderness and significant swelling along the bottom of the foot, often accompanied by bruising in the arch area. The physician may also be able to feel a palpable gap or defect in the fascia along the arch.
Diagnostic imaging is necessary to confirm the tear and determine its extent. Ultrasound is frequently the preferred initial tool because it can clearly visualize the fascia. An ultrasound can reveal a gap or discontinuity in the tissue, which confirms the tear.
Magnetic Resonance Imaging (MRI) may be used to confirm the diagnosis. MRI is effective at assessing the full extent of the tear. Identifying the rupture is important because its treatment protocol is far more restrictive than the management for plantar fasciitis.
Treatment and Recovery for a Plantar Fascia Tear
Treatment focuses on rest and immobilization. The initial management follows the R.I.C.E. principles. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and inflammation during the acute phase.
The foot requires a period of complete non-weight bearing, often followed by immobilization in a walking boot or cast for four to six weeks. After the acute phase, rehabilitation transitions to physical therapy, which initially focuses on restoring flexibility with gentle stretching of the calf and Achilles tendon.
As healing progresses, the physical therapy plan incorporates strengthening exercises for the foot and lower leg muscles. Supportive custom orthotics are often prescribed to provide long-term arch support and reduce tension on the healing fascia. Most plantar fascia tears heal well without surgery, with a recovery period lasting six to twelve weeks for the initial healing phase, but full return to high-impact activities may require several months of structured rehabilitation. Surgical intervention is considered rare and is reserved for cases where conservative treatment fails to relieve persistent symptoms.