Plantar Fascia Partial Rupture

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Plantar Fascia Partial Rupture

Authors, Editors, Case Information Author: Liga Kreitner, MD, MPH Affiliation: Mayo Clinic Co Author(s): Joshua M. Romero, M.D. and Jacob L. Sellon, M.D. Senior Editor: Carlton Covey, MD, MEd Clinical Vignette: A 26-year-old female presented with a three-year history of right plantar heel pain. She experienced a worsening of her symptoms for four months after a corticosteroid injection for plantar fasciopathy. Examination was remarkable for tenderness to palpation over the medial plantar heel, specifically over the medial calcaneal tubercle. Type of Probe Used: 4-18 MHz linear array transducer Unlabeled Long Axis View of the Plantar Fascia Central Cord Origin Unlabeled Long Axis View of the Plantar Fascia Central Cord Origin Labeled Long Axis View of the Plantar Fascia Central Cord Origin Labeled Long Axis View of the Plantar Fascia Central Cord Origin with a hypoechoic, concave region with loss of normal fibrillar architecture within the central portion of the central cord (measuring approximately 6.3 mm anterior to posterior). Plantar calcaneal enthesophyte () noted deep to the tear. Unlabeled Short Axis View of the Plantar Fascia Central Cord Origin Unlabeled Short Axis View of the Plantar Fascia Central Cord Origin Labeled Short Axis View of the Plantar Fascia Central Cord Origin Labeled Short Axis View of the Plantar Fascia Central Cord Origin demonstrating partial-width dimension of the tear (measuring approximately 6.3 mm medial to lateral). Thickened, hypoechoic, fasciopathic intact portion lateral to the tear (arrowhead). #5 - Video View Video Long Axis Cine of the plantar fascia central cord origin, redemonstrating a full-thickness tear. The intact medial and lateral portions of the central cord origin, just adjacent to the tear, appear mildly thickened with partial loss of fibrillar architecture, suggesting underlying fasciosis. #6 - Video View Video Short Axis Cine of the plantar fascia central cord origin from distal to proximal, redemonstrating a partial-width dimension of the tear as well as adjacent fasciosis in the intact medial and lateral portions of the central cord. Interpretation Image Interpretation:* The central portion of the plantar fascia central cord demonstrates a hypoechoic region with loss of volume and fibrillar architecture, consistent with a full-thickness, partial-width tear measuring approximately 6.3mm x 6.3mm. There is no associated hematoma, suggesting at least subacute chronicity. The intact medial and lateral portions of the central cord are mildly thickened with partial loss of fibrillar architecture, consistent with underlying fasciosis. Teaching Pearl: Plantar fascia disorders most often involve the proximal central cord. A focal hypoechoic defect with loss of fibrillar architecture should raise concern for partial rupture rather than simple fasciopathy. Ultrasound evaluation should describe the involved cord, defect size, and whether hematoma or perifascial fluid is present. Distinguish rupture from fasciosis by identifying a discrete volume or fiber defect, not just thickening. This distinction can be clinically relevant for load restriction and return-to-running decisions. References: 1. Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging. 2017;8(1):69-78. doi:10.1007/s13244-016-0533-2 2. Cocco G, Ricci V, Boccatonda A, Abate M, Guagnano MT, Schiavone C. Ultrasound follow-up of spontaneous tears of the plantar fascia treated with conservative therapies: two case reports. Medicine (Baltimore). 2019;98(52):e18428. doi:10.1097/MD.0000000000018428 3. Mosca M, Fuiano M, Massimi S, et al. Ruptures of the plantar fascia: a systematic review of the literature. Foot Ankle Spec. 2022;15(3):272-282. doi:10.1177/1938640020974889
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Plantar Fascia Central Cord Origin

Labeled Long Axis View of the Plantar Fascia Central Cord Origin

Unlabeled Short Axis View of the Plantar Fascia Central Cord Origin

Labeled Short Axis View of the Plantar Fascia Central Cord Origin

#5 - Video

#6 - Video

Interpretation

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