Plantar Fascia Rupture: Clinical Signs and Symptoms
A plantar fascia rupture presents with sudden, severe heel or midfoot pain accompanied by an audible "pop" or tearing sensation, immediate inability to bear weight, and characteristic medioplantar ecchymosis (bruising along the medial arch), which is the hallmark physical finding that distinguishes rupture from plantar fasciitis. 1, 2
Key Clinical Presentation
Acute Symptoms at Time of Injury
- Sudden severe pain in the sole of the foot, typically during acceleration maneuvers, running, or jumping activities 1, 2
- Audible "pop" or snapping sensation reported by the patient at the moment of rupture 1
- Immediate inability to bear weight on the affected foot following the injury 1
Physical Examination Findings
- Medioplantar ecchymosis (bruising along the medial arch of the foot) - this is the pathognomonic sign that should raise immediate suspicion for rupture rather than simple fasciitis 2
- Significant localized tenderness and swelling in the medial arch or at the calcaneal insertion 3
- Palpable defect may be present in the plantar fascia, though swelling can obscure this finding 3
- Difficulty or inability to bear weight on the affected foot during examination 3
Diagnostic Imaging
Initial Approach
- Radiographs are not typically helpful for diagnosing plantar fascia rupture itself, though they may be obtained to exclude other pathology 4, 5
- Ultrasound is the preferred initial imaging modality when rupture is suspected - it can quickly, accurately, and cost-effectively diagnose plantar fascia tears and is superior to MRI for rapid bedside diagnosis 2
Advanced Imaging When Needed
- MRI confirms the diagnosis by revealing partial or complete rupture of plantar fascia fibers with surrounding inflammation and increased tissue signal 1, 3
- Ultrasound findings include severe fasciitis at the calcaneal insertion with partial or complete tearing, increased plantar fascia thickness, and abnormal tissue appearance 2, 6
- US is usually appropriate as a focused examination for suspected acute tendinous rupture or plantar plate injuries when radiographs are normal or equivocal 4
Risk Factors and Clinical Context
Common Predisposing Factors
- Chronic plantar fasciitis is the most common predisposing condition 2, 6
- Prior corticosteroid injections significantly increase rupture risk 2, 6
- Sudden increases in physical activity or high-impact athletic activities (running, jumping sports, soccer, basketball) 1, 3
- Obesity and pes planus (flat feet) create increased plantar pressures and biomechanical stress on the fascia 7
Spontaneous Ruptures
- Spontaneous ruptures without predisposing factors are rare but do occur, even in healthy individuals with no history of trauma, plantar fasciitis, or steroid use 3, 2, 8
- These cases still present with the same cardinal signs: sudden pain, popping sensation, and medioplantar ecchymosis 3, 8
Location of Rupture
- Most ruptures occur at the calcaneal insertion (proximal attachment) 2, 6
- Distal ruptures (near the metatarsal heads) are less common and typically result from direct trauma, though spontaneous distal ruptures can rarely occur 8
- Mid-portion tears can also occur but are less frequent 3
Critical Pitfall to Avoid
Do not mistake plantar fascia rupture for simple plantar fasciitis - the presence of medioplantar ecchymosis, acute onset with a popping sensation, and immediate inability to bear weight distinguish rupture from the gradual onset morning heel pain typical of fasciitis 2, 6. Missing this diagnosis can delay appropriate treatment and prolong recovery.