Foot Muscle Tear - How Best to Recuperate? Member Case Study

author : AMSSM

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If I start back training too soon will I cause more damage or will I just stop the healing process? How long should it take for the muscle to heal completely?

Question from Antelope:

On September 26, 2004 I was in transition from bike to run. I was running barefoot in the transition area and I stepped on a large root with the middle of my heel. For about 4 weeks after, I had a bruise in the middle of my heel and the area was sensitive. I saw a podiatrist, he took X-rays and ruled out a stress fracture. For the next month and half I took anti-inflammatory and tried several different "pads" in my shoes. The problem still existed. I got an MRI on December 29 and it showed a torn muscle in the heel.

For the past 3 weeks I have been in an air cast and on crutches and was directed not to put any weight on the foot. My doctor says that I can now gradually start putting weight on the foot and in about a week and a half go back to normal walking. He has no idea about when I can go back to training, he basically told me to feel it out and see. If I start back training too soon will I cause more damage or will I just stop the healing process? How long should it take for the muscle to heal completely? Will weights isolated on the "bad foot" at the gym hurt or help (I feel that my good leg and ankle are now much stronger than my bad leg because of the double duty they have been doing)

Answer:

First, I want to make a few comments about your diagnosis. There are many muscles in the foot, but only a few in the heel area and muscle tears in the region of the heel are uncommon. It is possible that you tore your abductor hallucis, flexor hallucis, or flexor digitorum muscles, but there are not many others in the heel area. Other possible injuries include traumatic plantar fasciitis or “bruise” (bleeding into) the central heel fat pad.

All my comments apply to symptoms only localized to the “middle of your heel.” Stress fracture is unlikely because of immediate onset of your symptoms following trauma opposed to gradual buildup of symptoms with training (and your MRI confirms no fracture). It is difficult to answer specific injury questions without knowing exactly which structures are involved, but I will give it a try.

The question of when to start training is a good one, and often debated among sports specialists. Training, if progressed properly, may actually contribute to the healing process. I think one of the most valuable suggestions is to “let pain be your guide”. Not just immediate pain, but soreness after your workout and in the days following training (especially more than one or two) – I call this the symptom trend. Basic muscle tears usually heal in about 4-6 weeks, but this may vary depending on specific muscles and training loads. Weight lifting directed at your other leg muscles may help maintain conditioning, and sometimes a physician will allow cross-training with a cast or cast boot in a non- or low-impact setting (pool, stationary bike, etc.).

A few helpful tips regarding further treatment and return to activity include: consider a walking cast boot (Aircast Pneumatic Walker is a good one) with a foot orthotic inserted into the boot (Superfeet Green Capsule orthotics may be reasonable because they have a deep and well-molded heel cup which may help in your case) for a few weeks and then back to walking (no barefoot!) if pain-controlled; training progression that initially includes low-impact exercise (e.g., pool running, cycling, glider, etc) with gradual walk-run training progression as symptoms allow (start with workout broken into walk-run intervals with longer walk intervals initially and progress to shorter walk and longer run intervals until back to normal); stretching program that addresses flexibility of the heel cords and plantar fascia, and strengthening program focused on intrinsic muscles of the foot, arch muscles and even ankle. Ice the affected area for about 20 minutes after rehabilitation and workouts. Two techniques that work well in this area are: freeze water in a paper cup, rip off the top and grab the bottom to hold it as you massage over the injured area 7-10minutes, or freeze a plastic water bottle and sit with it under your foot rolling it under your arch 10-15minutes. Deep tissue massage may help. Let your immediate symptoms and your symptom trend guide you back to full training. If you develop persistent or recurrent symptoms, rethink the diagnosis.

These are general suggestions without knowing exact nature of your injury. I hope they are helpful, but they are not intended to take the place of your physician’s recommendations. Good Luck

Chris Madden, MD Member AMSSM

www.amssm.org
 

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date: April 9, 2005