Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

PF rupture

Posted by Debra H. on 2/04/03 at 18:29 (108004)

After rupturing my PF, I wore a cast for 4 weeks. I then tried to gradually return to normal activities over the past 5 weeks and I have worse pain than before rupturing the fascia in the first place. My doctor has put me on oral steroids. What do you think of this and what are my chances of recovery?

Re: PF rupture

Dr. Z on 2/04/03 at 20:07 (108010)

This can be a very tough case to handle. It can take six months to one year of physical therapy, casting, and ESWT. I have treated many patient with ESWT with this problem if it goes past the six month period and the pain is at the insertional part of the plantar fascia

Re: PF rupture

Debra H. on 2/04/03 at 21:33 (108024)

Why would the ESWT help a PF that is already ruptured? Plus, the pain is more lateral and posterior and in metatarsal region and not at the insertional part of the PF. What would you do for this?

Re: PF rupture

Dr. Z on 2/04/03 at 22:08 (108027)

You can right ESWT would only help at the insertion. I would place you in a cast boot and get you as much physical therapy as possible. You may need an orthosis. How long has this been going on ?

Re: PF rupture

Debra H. on 2/04/03 at 22:42 (108031)

It ruptured about 9 weeks ago. Before the rupture, I had a lot of more medial pain. The medial pain isn't as severe, but this other pain is at least as bad and possibly worse. I have worn orthotics for 8 years. I had new orthotics made just prior to rupture hoping this would help. Since it ruptured, I feel like I've traded one problem for another. I wear my orthotics religiously.

Re: Question for Dr. Z. PF rupture

Pauline on 2/05/03 at 11:48 (108087)

Dr. Z,
Here is a patient who was wearing orthotics for 8 years and still her P.F.
ruptured? Why does it happen and can it be prevented?

Re: Question for Dr. Z. PF rupture

Dr. David S. Wander on 2/05/03 at 12:44 (108091)

Assuming that the orthoses were worn all the time, the plantar fascia can still rupture from weightbearing. The orthoses should support the fascia and control pronation, but certain conditions can pre-dispose the plantar fascia/achilles tendon to weaken. Weightbearing still stresses these areas even with orthoses. Additionally, very few orthoses are actually functioning during the toe-off phase of gait and during toe off there is significant stress placed on the fascia. Although orthoses are used in treating plantar fasciitis, a rupture/partial tear can still occur. Hope that helps.

Re: Question for Dr. Z. PF rupture

Dr. Z on 2/05/03 at 18:50 (108126)

There are diseases such as Rhematoid Arthritis that can cause the pf to rupture with or without orthosis. There is the posssiblity of orthosis not working even with the patient wearing them all the time. And last but very important too many steriod injections. Or a steriod injection and then too much activity. Oh one more thing it happens and no one no why. How to prevent? Stretching,knowing that you can't continue to run fifty miles per weeks, excercise, proper shoes with orthosis if there is a biomechanical problem. Stay off hard surfaces such as cement. Have I left anything out?. This is a very good question. If you have orthosis have them checked out at least once per year. Just because you feet feel good doesn't mean they are working to control your abnormal biomechanics

Re: Question for Dr. Z. PF rupture

Pauline on 2/05/03 at 20:44 (108144)

If the PF is damaged by steroid, does it ever repair itself? Would it be in the same condition several years down the road?

Re: Question for Dr. Z. PF rupture

Dr. Z on 2/05/03 at 21:45 (108150)

I think it does to some extend. There is an article on this web site that states that only 50% get completely back to normal after a rupture from local steriod injections. The average number of local steriod injections was two that caused the rupture of the pf. What is the condition of pf years down the road after a rupture. I am not really sure . I believe some would be healed from the rupture and some will never heal. I have used ESWT on the ones that didn't heal and it resolved the pain

Re: To Dr. Z: For the record....

Debra H. on 2/05/03 at 21:46 (108151)

I had been under the care of a podiatrist for 4 months undergoing physical therapy including stretching, exercise modification,iontophoresis and ultrasound when my PF ruptured. My podiatrist said my orthotics seemed like they fit perfectly, but I had some remade just to rule this out as a possible cause. I would be happy if I could just work one day without foot pain by noon. I've never wanted to run 50 miles a week and certainly don't. But, I dream of being able to jog 3 miles/ 3 days a week and join a community basketball or volleyball league and play one day a week. I don't think this is asking too much since I'm only 30 and it would greatly benefit my overall health. But, I can't because I can't last even 30 minutes before I have crippling foot pain. I get foot pain before I get tired. I have top of the line workout shoes and I wear a Dansko as a dress shoe. I had 2 steroid injections by time the PF ruptured. I'm guessing the rupture was related to the steroid injection. And, I do not have rheumatoid arthritis.

Re: To Dr. Z: For the record....

Dr. Z on 2/05/03 at 21:51 (108155)

I can understand your foot pain which is very frustrating. It probaby was the local steriod injection. There is an article on this web site that talks about pf rupture and local steriod injections. You may have to be in a cast boot for 12 weeks to give your foot some rest. This is a very difficult problem and can take a vey long time , up to one year to improve
I wish I had a quick answer but I don't. Swimming could be helpful.

Re: ...the article part one

Dr. Z on 2/05/03 at 21:52 (108156)

Complications of Plantar Fascia Rupture Associated With Corticosteroid Injection
Paper No: 096
Thursday, February 13, 1997
12:17 PM

Location: Room 130-131, Moscone

Jorge I. Acevedo, MD, Duluth, GA
James L. Beskin, MD, Atlanta, GA

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. Subjective and objective evaluations were conducted through review of charts, radiographs, and a modified clinical scoring system. New problems observed after rupture included longitudinal arch pain, lateral midfoot pain, nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. Treatment included anti-inflammatory drugs, rest, stretching, orthotics, and boot-brace immobilization. At an average 25-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Ten feet were asymptomatic by 6- months postrupture, 4 feet by 12-months postrupture, and 26 feet remained symptomatic after 1-year postrupture.

Re: To Dr. Z: For the record....

Debra H. on 2/05/03 at 22:04 (108157)

I had been avoiding swimming because I had dislocated my shoulder and tore the labrum. It kept locking up so I had to have surgery to repair it. It's not perfect yet, but it feels better than my foot. So, I do now swim. I like it better than a stationary bike and can get a bit of an adrenaline 'fix.' It is a great exercise. But, since I am female and want to avoid osteoporosis when I'm old, I hope to eventually get back to a weight bearing exercise. Though I agree, in the meantime, it is better than nothing.

Re: ...the article part one

Debra H. on 2/05/03 at 22:08 (108158)

I don't find this encouraging because it says that 26 out of 51 (50 %)still had symptoms after 1-year and it doesn't say if they EVER got better. So, I have a 1 in 2 chance of getting better by 1 year. Are these the same statistics as if I had the PF surgically cut as apposed to a traumatic rupture? And, if so, why would anyone chose to have the surgery. If not, why is that?

Re: ...the article part one

Julie on 2/06/03 at 04:20 (108163)

That's a pretty horrifying statistic - 44 out of 51 PF ruptures associated with corticosteroids.

Re: PF rupture

Dr. Z on 2/04/03 at 20:07 (108010)

This can be a very tough case to handle. It can take six months to one year of physical therapy, casting, and ESWT. I have treated many patient with ESWT with this problem if it goes past the six month period and the pain is at the insertional part of the plantar fascia

Re: PF rupture

Debra H. on 2/04/03 at 21:33 (108024)

Why would the ESWT help a PF that is already ruptured? Plus, the pain is more lateral and posterior and in metatarsal region and not at the insertional part of the PF. What would you do for this?

Re: PF rupture

Dr. Z on 2/04/03 at 22:08 (108027)

You can right ESWT would only help at the insertion. I would place you in a cast boot and get you as much physical therapy as possible. You may need an orthosis. How long has this been going on ?

Re: PF rupture

Debra H. on 2/04/03 at 22:42 (108031)

It ruptured about 9 weeks ago. Before the rupture, I had a lot of more medial pain. The medial pain isn't as severe, but this other pain is at least as bad and possibly worse. I have worn orthotics for 8 years. I had new orthotics made just prior to rupture hoping this would help. Since it ruptured, I feel like I've traded one problem for another. I wear my orthotics religiously.

Re: Question for Dr. Z. PF rupture

Pauline on 2/05/03 at 11:48 (108087)

Dr. Z,
Here is a patient who was wearing orthotics for 8 years and still her P.F.
ruptured? Why does it happen and can it be prevented?

Re: Question for Dr. Z. PF rupture

Dr. David S. Wander on 2/05/03 at 12:44 (108091)

Assuming that the orthoses were worn all the time, the plantar fascia can still rupture from weightbearing. The orthoses should support the fascia and control pronation, but certain conditions can pre-dispose the plantar fascia/achilles tendon to weaken. Weightbearing still stresses these areas even with orthoses. Additionally, very few orthoses are actually functioning during the toe-off phase of gait and during toe off there is significant stress placed on the fascia. Although orthoses are used in treating plantar fasciitis, a rupture/partial tear can still occur. Hope that helps.

Re: Question for Dr. Z. PF rupture

Dr. Z on 2/05/03 at 18:50 (108126)

There are diseases such as Rhematoid Arthritis that can cause the pf to rupture with or without orthosis. There is the posssiblity of orthosis not working even with the patient wearing them all the time. And last but very important too many steriod injections. Or a steriod injection and then too much activity. Oh one more thing it happens and no one no why. How to prevent? Stretching,knowing that you can't continue to run fifty miles per weeks, excercise, proper shoes with orthosis if there is a biomechanical problem. Stay off hard surfaces such as cement. Have I left anything out?. This is a very good question. If you have orthosis have them checked out at least once per year. Just because you feet feel good doesn't mean they are working to control your abnormal biomechanics

Re: Question for Dr. Z. PF rupture

Pauline on 2/05/03 at 20:44 (108144)

If the PF is damaged by steroid, does it ever repair itself? Would it be in the same condition several years down the road?

Re: Question for Dr. Z. PF rupture

Dr. Z on 2/05/03 at 21:45 (108150)

I think it does to some extend. There is an article on this web site that states that only 50% get completely back to normal after a rupture from local steriod injections. The average number of local steriod injections was two that caused the rupture of the pf. What is the condition of pf years down the road after a rupture. I am not really sure . I believe some would be healed from the rupture and some will never heal. I have used ESWT on the ones that didn't heal and it resolved the pain

Re: To Dr. Z: For the record....

Debra H. on 2/05/03 at 21:46 (108151)

I had been under the care of a podiatrist for 4 months undergoing physical therapy including stretching, exercise modification,iontophoresis and ultrasound when my PF ruptured. My podiatrist said my orthotics seemed like they fit perfectly, but I had some remade just to rule this out as a possible cause. I would be happy if I could just work one day without foot pain by noon. I've never wanted to run 50 miles a week and certainly don't. But, I dream of being able to jog 3 miles/ 3 days a week and join a community basketball or volleyball league and play one day a week. I don't think this is asking too much since I'm only 30 and it would greatly benefit my overall health. But, I can't because I can't last even 30 minutes before I have crippling foot pain. I get foot pain before I get tired. I have top of the line workout shoes and I wear a Dansko as a dress shoe. I had 2 steroid injections by time the PF ruptured. I'm guessing the rupture was related to the steroid injection. And, I do not have rheumatoid arthritis.

Re: To Dr. Z: For the record....

Dr. Z on 2/05/03 at 21:51 (108155)

I can understand your foot pain which is very frustrating. It probaby was the local steriod injection. There is an article on this web site that talks about pf rupture and local steriod injections. You may have to be in a cast boot for 12 weeks to give your foot some rest. This is a very difficult problem and can take a vey long time , up to one year to improve
I wish I had a quick answer but I don't. Swimming could be helpful.

Re: ...the article part one

Dr. Z on 2/05/03 at 21:52 (108156)

Complications of Plantar Fascia Rupture Associated With Corticosteroid Injection
Paper No: 096
Thursday, February 13, 1997
12:17 PM

Location: Room 130-131, Moscone

Jorge I. Acevedo, MD, Duluth, GA
James L. Beskin, MD, Atlanta, GA

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. Subjective and objective evaluations were conducted through review of charts, radiographs, and a modified clinical scoring system. New problems observed after rupture included longitudinal arch pain, lateral midfoot pain, nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. Treatment included anti-inflammatory drugs, rest, stretching, orthotics, and boot-brace immobilization. At an average 25-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Ten feet were asymptomatic by 6- months postrupture, 4 feet by 12-months postrupture, and 26 feet remained symptomatic after 1-year postrupture.

Re: To Dr. Z: For the record....

Debra H. on 2/05/03 at 22:04 (108157)

I had been avoiding swimming because I had dislocated my shoulder and tore the labrum. It kept locking up so I had to have surgery to repair it. It's not perfect yet, but it feels better than my foot. So, I do now swim. I like it better than a stationary bike and can get a bit of an adrenaline 'fix.' It is a great exercise. But, since I am female and want to avoid osteoporosis when I'm old, I hope to eventually get back to a weight bearing exercise. Though I agree, in the meantime, it is better than nothing.

Re: ...the article part one

Debra H. on 2/05/03 at 22:08 (108158)

I don't find this encouraging because it says that 26 out of 51 (50 %)still had symptoms after 1-year and it doesn't say if they EVER got better. So, I have a 1 in 2 chance of getting better by 1 year. Are these the same statistics as if I had the PF surgically cut as apposed to a traumatic rupture? And, if so, why would anyone chose to have the surgery. If not, why is that?

Re: ...the article part one

Julie on 2/06/03 at 04:20 (108163)

That's a pretty horrifying statistic - 44 out of 51 PF ruptures associated with corticosteroids.