What is the management of a full-thickness rupture of the medial band of the plantar fascia?

From the Guidelines

Management of a full thickness medial band plantar fascia rupture should begin with conservative treatment for 6 weeks, as referral to a specialist is only considered if no improvement occurs after this period 1. The initial treatment approach should prioritize reducing stress on the fascia and promoting healing. This can be achieved through:

• Limiting weight-bearing activities and using assistive devices like crutches or a walking boot
• Implementing the RICE protocol (rest, ice, compression, and elevation) to reduce pain and inflammation
• Using NSAIDs such as ibuprofen or naproxen for pain management
• Utilizing a night splint to maintain dorsiflexion and custom orthotic inserts with medial arch support Key considerations in the management of full thickness medial band plantar fascia rupture include:
• The importance of early conservative treatment to promote healing and prevent chronic pain or instability
• The role of physical therapy in gentle stretching exercises for the plantar fascia and Achilles tendon, along with strengthening of intrinsic foot muscles
• The need for gradual return to activities, only beginning when the patient can walk pain-free
• The rare necessity for surgical intervention, which should only be considered if conservative measures fail after an extended period, typically 6 months or more, as suggested by the approach to treat heel pain 1. In the context of real-life clinical medicine, it is crucial to prioritize conservative management, given the potential for the plantar fascia to heal with adequate blood supply and proper biomechanics.

From the Research

Management of Full Thickness Medial Band Plantar Fascia Rupture

• The management of full thickness medial band plantar fascia rupture can be approached through conservative treatment, as seen in a case report where a patient underwent rest, immobilization, physiotherapy, rehabilitation, and a gradual return to activity, resulting in significant reduction in pain and improvement in functional mobility 2.
• A systematic literature review suggests that conservative treatment is the most commonly used approach, with an average duration of immobilization in a rigid walker of 2.6 weeks, and pain-adapted weight-bearing allowed in the majority of cases 3.
• Other treatment options, such as platelet-rich plasma (PRP) injections and extracorporeal shockwave therapy (ESWT), have been shown to be effective in reducing pain in patients with chronic plantar fasciitis, with PRP injections associated with better pain reduction results compared to ESWT 4.
• Ultrasound-guided PRP injection has also been reported to be effective in treating a patient with a plantar fascia tear, with decreased pain and useful for diagnosis, intervention, and follow-up 5.
• A systematic review of the literature suggests that conservative treatment leads to good outcomes in most cases, but operative treatment may be considered for chronic ruptures of the fascia 6.

Treatment Options

• Conservative treatment:
  • Rest
  • Immobilization
  • Physiotherapy
  • Rehabilitation
  • Gradual return to activity
• Platelet-rich plasma (PRP) injections
• Extracorporeal shockwave therapy (ESWT)
• Operative treatment (for chronic ruptures)

Considerations

• The rarity of spontaneous ruptures of the plantar fascia, especially in asymptomatic patients 6.
• The importance of considering the patient's history, symptoms, and diagnosis when determining the best course of treatment 2, 3, 6.