SLR - February 2015 - Matthew Tran

Risk Factors Affecting Chronic Rupture of the Plantar Fascia

Reference: Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, and Jeong JJ. Risk Factors Affecting Chronic Rupture of the Plantar Fasciaa. Foot Ankle Int. 2014 Mar; 35(3):258-63.

Scientific Literature Review

Reviewed By: Matthew Tran, DPM
Residency Program: Phoenixville Hospital

Podiatric Relevance: This article dealt with one of the most common diagnoses seen in our profession: plantar fasciitis. The authors retrospectively assessed the risk factors for plantar fascia rupture in patients with pre-existing plantar fasciitis.

Methods: There were a total of 286 patients within a four-year span that were involved in this study. All of the patients had been previously treated for plantar fasciitis. All diagnoses were based on subcalcaneal pain, tenderness in the plantar fascia, and post-static dyskinesia. Of the 286 patients, 35 of them developed plantar fascia ruptures. Ruptures were diagnosed in two steps: 1) palpation of the continuity and tension of the plantar fascia during dorsiflexion of ankle and MTPJ compared to the contralateral limb. Patients with loss of continuity were suspected of plantar fascial rupture, so further imaging was obtained (MRI/ US). Thirty five patients (26 via Ultrasound and 9 via MRI) were found to have plantar fascial ruptures via imaging.

Results: Patients involved in the study were then divided into two groups: rupture (n=35) and without rupture (n=251). Clinical characteristics were compared, including age, BMI, affected sites, and pain. Of the many characteristics that were compared between the two groups, the only correlation that could be made was that the percentage of patients (33 of 35) with steroid injections in the rupture group was significantly higher than the percentage of patients (62 of 251) with steroid injections in the nonrupture group.

Conclusions: It is important to note that the authors could not show a causal relationship between the timing of plantar fascia rupture and steroid injection due to retrospective nature of the study. Some of the patients could have had plantar fascia ruptures prior to the steroid injections. However, the authors concluded that the only correlative risk factor for a plantar fascia rupture was steroid injection. Therefore, steroids should be used cautiously because of the potential risk of plantar fascia rupture. 

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