Can a ground level fall exacerbate plantar fasciitis?

Can a Ground Level Fall Exacerbate Plantar Fasciitis?

Yes, a ground level fall can absolutely exacerbate plantar fasciitis by causing acute trauma to an already inflamed or degenerative plantar fascia, potentially worsening the underlying fasciopathy and increasing the risk of plantar fascia rupture.

Mechanism of Exacerbation

Acute trauma from a fall can worsen plantar fasciitis through several pathways:

• The plantar fascia is already in a state of chronic degeneration (fasciopathy) rather than active inflammation, making it more vulnerable to additional mechanical stress 1
• A fall creates sudden, uncontrolled loading forces on the plantar fascia that exceed the normal cyclical repetitive loading pattern, which is already a known aggravating factor 2
• The impact can cause acute microtrauma on top of existing chronic microtrauma at the plantar fascial insertion on the calcaneus 3

Risk of Rupture

The most serious concern is plantar fascia rupture, which is a recognized complication:

• Plantar fascia rupture can occur in patients with existing plantar fasciitis, particularly after acute trauma 4
• This risk is heightened in patients who have received corticosteroid injections, as these can weaken the fascia and predispose to rupture 2
• Rupture presents as sudden, severe pain and can be diagnosed with ultrasound (69% diagnostic accuracy) or MRI 5

Clinical Presentation After Fall

Patients will typically report worsening of their characteristic plantar fasciitis symptoms:

• Intensified stabbing pain at the proximal medioplantar surface of the foot, particularly with first steps in the morning 1
• Increased tenderness to palpation at the anteromedial calcaneus where the plantar fascia inserts 1
• Sharp pain with passive ankle and first toe dorsiflexion 6
• Pain that worsens at the end of the day after the acute injury 1

Diagnostic Approach Post-Fall

If a patient with known plantar fasciitis experiences a fall and has worsening symptoms, imaging should be obtained:

• Weightbearing radiographs should be the initial study to exclude fracture and evaluate for other pathology (85% sensitivity, 95% specificity) 4, 5
• Ultrasound is appropriate for evaluating potential plantar fascia rupture (69% accuracy for rupture detection) and can assess for increased fascia thickness (>4mm is abnormal) 5
• MRI should be considered if rupture is suspected or diagnosis remains uncertain, as it is the most sensitive imaging modality for characterizing the plantar fascia and adjacent structures 4, 5

Management Modifications

Treatment should be intensified after acute exacerbation:

• Immediate rest and activity modification to decrease cyclical repetitive loading is essential regardless of treatment modality chosen 2
• Ice massage and oral analgesics for acute pain control 6, 1
• Plantar fascia-specific stretching and calf stretching should continue once acute pain subsides 2
• If rupture is confirmed, more aggressive immobilization may be required and surgical consultation should be considered for complete ruptures 4

Important Caveat

Avoid corticosteroid injections in the acute post-fall period, as the fascia is already compromised and injection carries risk of fat pad atrophy and plantar fascia rupture, with only short-lived pain relief benefits 2.