Plantar Fascia Rupture

National news was abuzz recently when Denver Broncos future Hall of Fame quarterback Peyton Manning recently ruptured his plantar fascia.  Now, anytime you hear the word “rupture” in sports, particularly in someone with Peyton Manning’s fame, it leads the headlines.  Fans are nervous and deflated, the “haters” have a collective chuckle or sigh of relief when the nemesis is incapacitated.  So what’s the big deal with plantar fascia ruptures?

What’s the plantar fascia?

The plantar fascia is a thick band of tissue that runs from the heel to each of the toes. Basically, it serves to support the arch of the foot and helps stabilize the foot during gait.  Think of it as a spring that runs from the heel to the toes.

What causes the plantar fascia to rupture?

Any athlete that runs or jumps is at risk for a rupture, but any athlete who spends their time on their toes is at risk too (i.e. boxers, dancers).  Athletes with a history of chronic plantar fasciitis are at risk.  Steroid shots have also been implicated as a contributing factor in plantar fascia ruptures.   It is the very essence of a “Catch-22” with steroid shots – they help with pain and dysfunction, but over time, they weaken the tissue, making it susceptible to rupture.  Risk of rupture after steroid injections has been reported in the literature.

What are the symptoms?

Usually, athletes report hearing and feeling a “pop” on the bottom of the foot.  They may even be able to see and/or feel the fascia rolled up in the foot.  Pain, swelling, and the inability to walk are also signs of it.

What are the problems with a plantar fascia rupture?

Some may perceive that if it’s painful and bothersome, a rupture might be a good thing.  Sometimes it is.  In an athlete though, it could be problematic.  The support on the bottom of the foot is lost and stress fractures may result in the metatarsals, particularly on the lateral side as athletes tend to shift weight to the lateral border of the foot.  At a minimum, the arch is flattened and may result in pain or cause other problems, similar to people that have “flat feet.”

Do you have surgery to fix a plantar fascia rupture?

No.  Sounds crazy, but the tear is left “as is.”  Sounds like a big deal, but it’s really not with a custom orthotic and good rehab.

Physical therapy for plantar fascia rupture

Athletes are typically non weight-bearing for a couple of weeks.  After this initial period, athletes usually transition to a boot and then will transition to shoes once they have normal gait and minimal pain by 4-6 weeks.  Because the support of the fascia is missing, it is critical that athletes get custom orthotics to support the foot.  Additionally, intrinsic foot strengthening is needed to strengthen the arch muscles since the fascia is no longer there to support it.  It is recommended that athletes complete a comprehensive program of proximal hip strengthening, soft tissue work to the foot, and progressive return of functional activities.  Pool exercises are also a great adjunct to land-based treatment.

So how long does it take to get back to sports?  Well, a 2004 study in the Am J Sports Med found that in a group of 18 athletes with plantar fascia ruptures, the average time to return to sport was 9 +/- 6 weeks.  Much of that depends on the sport the athlete plays, the level of competition, as well as the size of the athlete.  Hard to predict at this time when Peyton Manning will be back running the Broncos offense.
The physical therapists at SSOR have treated plantar fascia ruptures and know how to get you back to the activities you enjoy.  It would be a privilege to serve you and partner with you in your care.  We have locations in Overland Park and Prairie Village to serve you.

Tags: Overland Park, Peyton Manning, Physical Therapy, plantar fascia rupture, prairie village