Arch Pop

author : AMSSM

comments : 0

I recently just ran a 5 mile race, and in the last 100 meters I was sprinting to pass someone and I felt a "pop" in my left arch. Could I have strained it? What is your advice for healing?

Member Question

I recently just ran a 5 mile race, and in the last 100 meters I was sprinting to pass someone and I felt a "pop" in my left arch. It was extremely painful (although I managed to still beat my fellow contestant. I iced, rested and iced it some more for the rest of the day. There was minimal bruising the next day, but it's still very tender in my heel. Stretching it on the tepee ball has helped and I am able to walk on it, just without putting all my weight on it. I know that facial rupture is possible, but I don't think that it is that serious. What is your advice for healing and how much activity? I biked today with minimal pain and just a little tightness. I am worried about being able to continue my training plan and allowing it to heal at the same time. Could I have strained it?

Answer from Marjie Delo, MD, CAQSM
Member AMSSM

If you felt a pop and subsequently had bruising near the heel on the sole of your foot, I would be worried about a partial tear of the plantar fascia.  I agree with you, that if you are weight bearing on the foot without too much pain, the chance that you completely ruptured the fascia is low.  Of course, the worst case scenario is a stress fracture of your calcaneus (heel bone), and I would recommend getting an xray taken to rule-out an injury to the bone before advancing activity.

A partial tear of the plantar fascia usually occurs when there has already been weakening of the structure from plantar fasciitis.  The plantar fascia is a thick connective tissue sheath that protects the base of the foot and helps support the normal arch architecture.  A combination of abnormal forces acting on the plantar fascia can lead to microscopic partial tears and weakening of the structure.  These abnormal forces can include tightness in the Achilles and calf musculature, abnormal foot mechanics such as pronation or rigid high arches, and increased training loads without adequate recovery.  Once the plantar fascia is weakened, it is prone to partial or complete rupture.

Treatment of a tear in the plantar fascia is similar to treatment for plantar fasciitis, but because the injury is more severe, recovery may take longer.  Initially, you should have your biomechanics assessed (lower extremity muscle tightness or weakness, running form, training shoewear) and correct any risk factors.  You should be able to continue biking and swim training, just avoiding a lot of standing hill climbs on the bike until your symptoms are improving.  You should add running mileage back in very slowly, without running on back-to-back days and staying on soft surfaces.  Rehab exercises should be focused on your biomechanical abnormalities, but in general, the following help with plantar fasciitis:  calf stretches, myofascial release with either a foam roll or a trigger point device to the calves and arches, and night splints. 

Other treatment options include formal physical therapy, short term use of a cast boot, or cortisone injections.  If you had a partial tear, I would try to avoid an injection as cortisone can further weaken the plantar fascia.  Good luck returning to your training!  If you are able, I would suggest being evaluated by a physician trained in sports medicine.  Xrays could be obtained, and if still in question the diagnosis of a plantar fascia tear can easily be diagnosed in the office using musculoskeletal ultrasound.

Marjie Delo, MD, CAQSM
Lakeshore Orthopaedics
Manitowoc, WI

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date: May 29, 2012