Plantar Fascia Rupture in Plantar Fasciitis Ho Seong Lee · Jae Jung Jeong* Department of Orthopaedic Surgery, Asan Medial Center, Ulsan University, seoul, Korea * The Catholic University of Korea, Daejeon St. Mary’s Hospital

Plantar Fascia Rupture in Plantar Fasciitis Ho Seong Lee · Jae Jung Jeong My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

Rupture of Plantar Fascia • 1st report of plantar fascia rupture in athletes Leach R, JBJS(Am), 1978

• Considered as acute injury occurred in athletes

• Plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis - Spontaneous rupture in old age

Pai V, J F&A Surg, 1996

- Plantar fascia rupture after plantar fasciitis Acevedo J, FAI, 1998

Rupture of Plantar Fascia

• lateral foot pain : weakened medial arch, compressive force on lateral side

• poor definited mid-foot pain & weakness : longitudinal arch strain, lateral & dorsal mid-foot strain

• lateral plantar nerve dysfunction : d/t loss of arch support resulting in hyperpronation • Metatarsal stress fracture

• Hammer toe deformity d/t inefficiency of the intrinsic flexor & plantar aponeurosis

• Swelling & antalgia

(Acevedo, FAI, 1998)

Purpose • To analyze risk factors causing plantar fascia rupture in preexisting plantar fasciitis

Material • Mar. 2004 – Feb. 2008 • Retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics

METHOD • Patients were divided into patients with or without a plantar fascia rupture • There were 35 patients in the rupture group and 251 in the non-rupture group • We compared age, gender, the affected site, the VAS score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the two groups.

Diagnosis of rupture • Plantar fascia rupture with preexisting plantar fasciitis was diagnosed in 2 steps • palpating the continuity & tension of the plantar fascia during passive DF of Ankle and MTP joint. comparing with contra-lateral side • The plantar fascia rupture was confirmed by ultrasonography or MRI

RESULTS Plantar fasciitis (286 patients) Total

With rupture

Without rupture

Patients (N)

286

35 (12.2%)

251 (87.8%)

Age

54.8

58.5

54.4

Male

105

12

93

Female

181

23

158

Right

111

15

96

Left

121

20

102

Bilateral

53

0

53

Gender

Foot(N)

P-value

0.168 0.852

0.770

RESULTS With rupture (n=35)

Without rupture (n=251)

P-value

VAS

5.6

6.0

0.266

BMI (kg/m2)

25.0

25.2

0.780

Steroid injection

33 (94.3%)

62 (24.7%)