By William O. Roberts, MD
Abridged from www.runnersworld.com
The plantar fascia is a tough band of connective tissue that spans the longitudinal axis of the foot between the heel bone (calcaneous) and the base of the proximal phalanges. The tissue forms the tension portion of the tension-compression structure that makes up the longitudinal arch and it resists the pressure on the arch to fall flat. It also acts as a “windlass” to tighten the longitudinal foot to toe when walking and running. Micro tear injury is called plantar fasciitis and is relatively common in runners and others. Plantar fascia rupture is a relatively uncommon injury and the onset is often associated with a vigorous foot plant. In three words, it really hurts.
A plantar fascia partial tear is not generally considered a surgically repairable injury because it usually heals well on its own and the surgical access might have more risk of scarring than the potential for improvement. The treatment is non-operative and healing the tissue back to full strength takes 12 or more weeks. The usual treatment is to control the pain, put the arch and foot at rest to allow the tissue to reconstruct, and as the symptoms begin to settle over a week or two, begin gentle stretching and limited, protected walking. Normal standing or walking may be possible in a few weeks. The return to high level running may require several months.
There are some studies underway to see if platelet-rich plasma (PRP) injections can speed healing and improve outcomes, but they are in the experimental stages and are expensive.
Surgeons love to operate and one of my rules for decision-making is quite simple – if a surgeon says there’s no surgical option, there likely isn’t one. If you look hard enough you can probably find someone to cut and sew, but the outcome may not be great. It is also critical to remember that there is nothing a little surgery cannot make worse.
With regard to the surgeon’s comments, the tears usually heal as long as you do not do too much, too fast and damage Mother Nature’s repair job. For people with chronic plantar fasciitis, a complete tear is often the cure. I think your son is better off if he can keep the tissue intact. He should follow the return to running protocol carefully and cut back at the first sign of pain or discomfort. A simple rule of thumb for soft tissue healing, if not disrupted by re-injury, is 20% at 2 weeks, 80% at 6-8 weeks, and 100% at 12 or more weeks.