Friday, December 31, 2010
Plantar Fascial Tear: Possible Cause of Unresponsive Plantar Heel Pain
After seeing what the normal plantar fascia should look like here is my patient Kate with her plantar fascia torn at the attachment into the heel. If you try to follow the black line from the arch where the fascia looks normal towards the heel (to the right), you can see that there is disruption of the black line. The thin black line attaching into the heel is replaced with grayish thick scar tissue. The scar tissue and plantar heel swelling extends downward through the fat layer (where it does not belong) to the plantar skin (at the bottom of your foot. Just looking at this MRI image and you can tell Kate is in alot of pain.
Kate never felt the tear, and just thought she had very bad plantar fasciitis. You can only really treat this one way initially, 3 monthes in a removable cast to limit the bend at the toes. After the casting, and only when you are comfortable walking, you can begin to wean out of the cast into some form of supportive orthotic devices to support the arch. Most patients need alot of physical therapy with deep tissue work to break down the scar tissue which always over does it. While you are in the cast, you can do pain free activities (biking, ellyptical as it calms down, some swimming, etc), icing, stretching (pain free), and foot strengthening (crucial, but must be pain free).
Here are a copy of links that tie into to this article.