Ruptures of the Plantar Fascia: A Systematic Review of the Literature

Abstract

Introduction Rupture of the plantar fascia is a rare condition. It can also occur spontaneously and with no history of disease of the plantar fascia, above all in athletes. This review aims to systematically analyze all cases described in the literature regarding the rupture of the plantar fascia, evaluating incidence, risk factors, and treatments, considering which procedures show the best outcomes and the highest success rate. Materials and methods A systematic review of PubMed, Google Scholar, and Cochrane review computerized databases was performed, focusing on articles about cases of rupture of the plantar fascia; 18 studies fulfilled all the criteria and were analyzed. There were no randomized controlled trials. Results A total of 155 patients (157 foot) were included in this systematic review. Considering all the studies included, 12 patients had a spontaneous rupture, 138 patients had a diagnosis of plantar fasciitis, and 130 patients were treated with local injections of corticosteroid before the rupture. Only 2 cases of bilateral rupture were reported. In all, 15 studies reported conservative treatment, with a total of 154 patients (156 feet) included. Operative treatment was reported in 3 studies, with 3 patients (3 feet) treated. Conclusions Ruptures of the plantar fascia are very rare in asymptomatic patients and more common in patients treated with injection of steroids in the plantar fascia. Conservative treatment, although not standardized in the literature, led to good outcomes in most cases. Chronic ruptures of the fascia should be considered for operative treatment. Levels of Evidence: Level III

Plantar Fascia Lateral Fascicle Rupture: How Severe Can It Be?

“…Moreover, even though some cases of lateral fascicle plantar fasciitis have been described [5], we did not find any report on plantar fascia lateral fascicle rupture. Plantar fascia ruptures, usually pertaining to the central fascicle, can be divided into spontaneous or acute-on-chronic, with the latter being the most frequent one [6,8]. On the one hand, spontaneous ruptures usually occur in patients without any previous symptoms and present with a popping sensation, pain on the foot plantar surface, and ecchymosis [6].…”

“…On the one hand, spontaneous ruptures usually occur in patients without any previous symptoms and present with a popping sensation, pain on the foot plantar surface, and ecchymosis [6]. On the other hand, patients with acute-on-chronic ruptures usually have a history of plantar fasciitis, with many patients reporting previous corticosteroid injections, as well as milder symptoms compared to spontaneous rupture [6,8]. In both cases, patients are usually middle-aged males with a high-level, or even professional, athletic activity [6,8].…”

“…On the other hand, patients with acute-on-chronic ruptures usually have a history of plantar fasciitis, with many patients reporting previous corticosteroid injections, as well as milder symptoms compared to spontaneous rupture [6,8]. In both cases, patients are usually middle-aged males with a high-level, or even professional, athletic activity [6,8]. These ruptures can be partial or complete [9] and the mechanism described is an acceleration type of motion [10].…”

“…These ruptures can be partial or complete [9] and the mechanism described is an acceleration type of motion [10]. The diagnosis is usually clinical with MRI employed in differential diagnosis and to properly characterize the injury [8]. The typical MRI finding is a high T2 signal partially or completely interrupting the low signal of the plantar fascia [8].…”

“…The diagnosis is usually clinical with MRI employed in differential diagnosis and to properly characterize the injury [8]. The typical MRI finding is a high T2 signal partially or completely interrupting the low signal of the plantar fascia [8]. As for the treatment of plantar fascia rupture, no formal guidelines currently exist; however, many authors have suggested that minimum possible immobilization, pain-adapted weight bearing, thrombosis prophylaxis, non-steroidal anti-inflammatory drugs (NSAIDs), ice, and physiotherapy play an important role, as stated in a systematic review by Debus et al [6].…”