Plantar Fascia Rupture Rehab
The plantar fascia is the thick fibrous connective tissue at the bottom of your foot that supports the arch and provides shock absorption. It starts at the heel bone (calcaneus) and finishes at the base of your toes (metatarsals).
Dorsiflexion and toe extension are two actions of the ankle and foot, respectively, and these actions occur during walking as your toes are about to leave the ground in preparation for swinging the leg forward. This action puts the plantar fascia under tension, which in turn stabilises the foot. This tension reduces the need for muscle contribution as the fascia provides dynamic stability to the foot when in a loaded position.
You have probably heard of “plantar fasciitis”, but this term is misleading as ‘itis” indicates inflammation, yet there is a lack of inflammatory cells with this injury. More accurately, it can be referred to plantar heel pain or plantar fasciopathy as it is a degenerative condition.
When plantar heel pain is present, whether it be due to sudden overload in activity or a long term issue, the fascia is much more susceptible to tearing/rupturing.
What will your rehab involve in the case of a rupture or partial rupture?
A period of immobilisation: This is to reduce/eliminate weight bearing for weeks to months to promote tissue healing. This can be achieved through crutches or a cam boot depending on the severity of the tear. A cam boot is great for a lower grade tear as it allows for the person to weight bear in a supportive and comfortable environment.
Isometric and small range of motion exercises: Examples are foot exercises (such as towel scrunches) and calf raises from a neutral position. We do not want to put the plantar fascia on stretch/under tension during this phase (eg hanging your heel off a step) as the tissue is still healing.
Larger range of motion exercises: The range of motion of the exercises will progressively increase to encourage the fascia to perform its role as a shock absorber and supporter for the arch under more load.
Introduce higher load exercises: these are exercises like hopping, jumping, running, etc. Again, the key is slowly reintroducing these exercises so the fascia is prepared and ready to accept these loads before demand increase.
Sport specific exercises: this is the return to sport period and the requirements of your sport will determine the exercises.
Progression through the stages will depend on healing time and your individual presentation, which significantly varies from person to person. Rehabilitation should be conducted by your health professional as they will be able to tailor the program to you, so as to ensure the most optimal recovery.