Surgical Repair of Complete Plantar Fascia Ruptures in High-Demand Power Athletes: An Alternative Treatment Option

• Published in: The Journal of foot and ankle surgery 2020-01, Vol.59 (1), p.195-200
• Main Authors: Schaarup, Susanne Olesen, Burgaard, Peder, Johannsen, Finn Elkjær
• Format: Article
• Language: English
• Subjects: acquired flatfoot; operative repair; plantar aponeurosis; plantar fascia repair; reverse windlass mechanism; windlass stretch test
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2019.07.018

Surgical repair of complete plantar fascia ruptures has not yet been reported in the literature. Operative technique and outcome are described in 2 gymnasts with heavy plyometric demands who received surgical repair compared with 3 athletes treated nonoperatively. Biomechanics and clinical implications are discussed. In the last 8 years, we have seen 5 high-demand athletes with total rupture of the plantar fascia. This is a retrospective clinical evaluation 1.5 to 8 years postinjury of all 5 patients using dynamic ultrasound, Foot Function Index, sports-specific questions, Foot Posture Index, and foot length. The operated gymnasts returned to the same level of performance within 12 months. None of the conservatively treated athletes returned to preinjury plyometric sports levels but reached a foot load capacity of distance running with the injured foot as limiting factor. Ultrasound with simultaneous dorsiflexion of the toes showed a normal fascia in the operated patients, but a slack fascia that tightened up only at terminal toe dorsiflexion in the conservatively treated group. According to the Foot Function Index, the operated patients reported no complaints, whereas the nonoperative group had clinical relevant impairments in activities of daily life. The Foot Posture Index in all nonoperated patients showed a relative shift toward pronation with increased foot length compared with the noninjured foot. The operated patients showed no difference in foot length but minimal shift into supination with a slightly altered arch contour. Surgical repair of plantar fascia ruptures is technically feasible to restore normal foot load capability with return to high-demand plyometric sports within 12 months.