Acute Tear Of The Plantar Fascia In A Football Player

History A22-year-oldcollegewidereceiver sustainedaright foot injury during football training camp.Thepatient reports that heplantedwith his right foot whilerunning arouteandheardapopontheplantar surfaceof his right foot. Heimmediately endorsedpainwith troubleweight-bearing.Thepatient reportedpainover theplantar calcaneal regionthroughout theplantar fasciadistribution. Thepatient notedpaintraveling uptotheAchilles andacalf as well. Thepatientendorsedhaving ahistory of anklesprains, but noother significant injury or surgery reported. PHYSICAL EXAMINATION Examinationinthetraining room revealedswelling over theplantar surfaceof thefoot throughtheplantar fascia. Therewas noecchymosis. Therewas tenderness over theproximal 3rdoftheplantar fascia. Achilles tendonwas without swelling, nodularity or tenderness. NegativeThompsontest. FHL activationwas normal with 5/5strength. 5/5anklestrength inall directionswith theexceptionof plantar flexion. Passivegreat toeextensionelicitedseverepainintheplantar calcaneal region. DIFFERENTIAL DIAGNOSIS 1. Plantar FasciaTear2. Lisfranc Injury3. Medial Plantar Nerveinjury TEST AND RESULTS X-rayoftheleftfoot- Ossiclesnearthemedialmalleolus.Noacutefracture,dislocation,orotherosseousorsofttissueabnormality.MRI LeftFootwithoutcontrast-SeverePlantar Fasciitis with high gradepartial tear. Final Working Diagnosis High gradepartial tear of thePlantar Fascia. TreatmentandOutcomes1. High anklecambootwith akneescooterandnon-weightbearingmobilityfor3weeksafterdiagnosiswith agradualprogressiontoweightbearinginhigh anklecamboot8weekspostdiagnosis.2.Rehabilitationwasinitiatedduringweightbearingprogressionfocusedongentlestretching,anklerangeofmotionandproximallowerextremityexercisestopreventdisuseatrophy. 3.Ambulation in cushioned insole arch supports 12 weeks post diagnosis. Focus placed onpassive/direct therapy techniques and addition of weight bearing activities as tolerated.4.Ultrasound guided PRP injection with tenotomy was performed of the plantar fascia 4monthspost diagnosis.5.Underwent 12 weeks of physical therapy and sport performance training before return to playwhen he was able to meet the demands of his sport.