Plantar Fascia Strain – Medial Arch Strain

Summary

A plantar fascia strain can cause chronic discomfort in the arch of the foot. It is sometimes referred to as a medial arch strain. The classic location of discomfort in a plantar fascia strain is the inside (medial) aspect of the arch (Figure 1). This location of pain is different from what is seen in plantar fasciitis –a more common condition characterized by chronic heel pain. Most patients with pain from a chronic medial arch strain respond well to conservative treatment.

Plantar Fascia Strain Location of Pain — **Figure 1: Common Location of Pain in Plantar Fascia Strain (Medial Arch Strain)**

Symptoms of a Medial Arch Strain

Many of the microscopic tears in the arch do not create any symptoms. However, some plantar fascia strains produce localized discomfort. This pain is typically localized on the inside and/or central area of the arch. The location of pain seen in a medial arch strain is quite different than the heel pain present in the more common condition of plantar fasciitis. As the arch is loaded during standing and walking, more traction force usually goes through the inside (medial) aspect of the plantar fascia compared to the outside (lateral). Chronic attritional tearing of the plantar fascia in this area occurs in the same way that repetitively loading a rope over time can lead to tearing of some of the fibers of the rope. In the body, this sort of microscopic injury elicits a healing response. This includes increased blood flow to the area which brings healing elements, including inflammatory mediators. This healing response from the body can lead to local discomfort in the arch. Symptoms if present are usually worsened by standing, walking, and dynamic activities –anything that creates increased traction loading through the sole of the foot. Symptoms of a plantar fascia strain often develop gradually. Although, a sudden onset of symptoms can occur with an increase in activity that precipitates the microscopic tearing of the arch. An acute onset of marked pain in the arch that makes walking difficult or impossible is more likely to be from a plantar fascia rupture. A plantar fascia rupture is different from a medial arch strain. It is a much more extensive tearing of the plantar facia which happens acutely.

Physical Exam Findings often seen with a Plantar Fascia Strain

Typically, patients with a symptomatic plantar fascia strain will have localized discomfort with palpation over the inside (medial) aspect of the arch of their foot (Figure 1). There may be an area of roughness or small thickened bands of tissue that are painful. A large nodular mass that is not particularly painful is more likely to be a plantar fibroma rather than a plantar fascia strain. Commonly patients with a plantar fascia strain will have a flatfoot as this foot shape will increase the load through the plantar fascia on the inside of the arch. Patients may also have a tight calf muscle (equinus contracture) as this will also increase the force that the plantar fascia is subject to.

Imaging Studies

Plain weight-bearing x-rays of the foot will usually be normal or will demonstrate evidence of a flatfoot deformity. An MRI or ultrasound may demonstrate small tears of the plantar fascia in the area of the arch. Alternatively, evidence of the body’s attempts to repair this microscopic tearing may be seen with thickening and scar tissue in this area of the plantar fascia.

Treatment of a Plantar Fascia Strain (Medial Arch Strain)

A medial arch strain can be treated conservatively. Usually, patients can still walk, albeit with some discomfort in their arch. Initial treatment may include:

Limiting activities that require standing, walking, or explosive athletic movements
Wearing supportive comfort shoes
Using a soft medial orthotic arch support
Anti-inflammatory medication if tolerated

This initial treatment is followed by a gentle exercise program, including local massage, plantar fascia specific stretching, and calf stretching. This is done in order to minimize local scarring and improve the flexibility of the planter fascia tissue. Often, this can be carried out by the patient over 1-2 weeks. However, if symptoms are more pronounced treatment by a physical therapist may be beneficial.

Once symptoms have resolved, a graduated return to normal activity and athletics can be started. The use of comfort shoes, soft orthotics, and regular plantar fascia stretching should be continued even after symptoms have resolved. Recurrence of symptoms related to a plantar fascia strain is fairly common. There is also a slight risk of a plantar fascia rupture occurring in the future.

August 30th, 2024