Complications of Plantar Fascia Rupture Associated with Corticosteroid Injection

Abstract

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics

“…In either case, histologic evidence of inflammation has been lacking, and therefore the term, 'plantar fasciopathy' is preferable to 'plantar fasciitis' [10] [9]. Athletes may also present with acute rupture, which may occur on the background of a chronic plantar fasciopathy, often with a history of previous steroid injection [11] [12].…”

Plantar fasciitis treatment: What is better, oral nonsteroidal anti-inflammatory agents or locally injectable steroid?

“…[2] Long-term use of oral NSAIDs can cause serious systemic side effects like gastritis, peptic ulcer, esophagitis, gastrointestinal (GI) bleeding, interstitial nephritis, Na + and water retention, thrombocytopenia, bleeding, pruritus, central nervous system, and hepatic complications 5 , whereas in case of steroid injections chances of systemic side effects are very rare as it is injected locally, but steroid injection for plantar fasciitis is often associated with local site erythema, plantar fascia rupture, and fat pad atrophy. [14,15] In our study the group I patients had a high complication rate, 18 patients had complaints of gastritis, 3 cases had pruritis, 1 case was diagnosed with esophagitis, these complications are commonly seen in other studies with NSAIDs. In group II, one patient had plantar fascia rupture (3.33%), and one patient each had injection site erythema and infection.…”

Sporcularda plantar fasya rüptürleri

“…[1,[9][10][11][12][13][14] Kortikosteroid enjeksiyonları PF rüptürlerinde sorumlu tutulan bir faktör olsa da, enjeksiyon sonrası rüptür oranının düşük olduğu söylenebilir. Kim ve ark., kortikosterid enjeksiyonu ile tedavi edilmiş 120 plantar fasiitis hastasını geriye dönük olarak değerlendirdikleri çalışmalarında, sadece üç olguda rüptür rapor etmişlerdir.…”