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Tuesday, January 16, 2018

Why do partial tears hurt more than complete tears?

Hi Dr. Blake,

Thank you so much. It is so frustrating to have doctor after doctor call this "plantar fasciitis"...the podiatrist yesterday told me that "if there is a tear, I don't think that's what's bothering you because the surgery to fix plantar fasciitis is actually cutting the plantar fascia." While that may be true, there's also a pretty extensive recovery period for that! May I ask what your opinion is on EPAT and if that would speed the healing process? Also what type of exercise would be considered "safe"? Swimming? Biking?

Thank you!!!

Dr. Blake's comment: This patient is struggling with a partial tear of the plantar fascia. I have only found them to heal with 4-6 months of no stretching and no tension allowed on the plantar fascia (with a removable boot or hike and bike shoe to not allow bending of the big toe joint). The doctor's comment revealed a lack of understanding (sorry!!) of why partial tears hurt more than complete tears. This is so true, and better explained, with the Achilles tendon. When someone completely tears the Achilles, or an ankle ligament, the immediate pain is severe, but then they have relatively no pain. They only have the instability caused by the injured structure not doing its job because it is torn. With a partial tear, the ligament, or tendon, is trying to work when stressed, but the weakest link in the chain is the tear, and that will hurt when stressed. A 10% tear of the Achilles can hurt much more than a complete tear of the Achilles. I have seen patients who have torn their plantar fascia completely, completely recover. But I have seen patients who have their plantar fascia cut in surgery for chronic plantar fascia, who are left with a flat foot or other foot issues. My recommendation is to rest it the next 4-6 using the plantar fascia tear protocol in this blog and be done with this injury. 
     I am sure that there is a role of EPAT, PRP, stem cells, etc for these injuries. I think you must immobilize them anyway to take the tension off the structure. Will they speed up the 4-6 months? I am not sure. Swimming for a plantar fascial tear can be okay, definitely no fins or pushing off the wall. Cycling seems to be fine, initially, I do not have my patients get off their seats. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.