Overcoming Misdiagnosed Plantar Fascia Injury
Week In Review – Diagnoses, Imaging, and the Power of Conservative Care
In this week’s episode of Week In Review, the clinicians at The FARM dive into two illuminating cases that emphasize the importance of clinical reasoning, patient-centered care, and the pitfalls of over-reliance on advanced imaging. These stories—one involving a misdiagnosed plantar fascia rupture and the other a classic lumbar pars injury—demonstrate how a grounded, movement-based approach can outperform invasive interventions when applied with precision and patience.
Case 1: The Misdiagnosed Plantar Fascia Rupture
The first case involves an athlete who was referred to The FARM following an MRI report indicating a partial rupture of the plantar fascia. The patient presented with classic heel pain and a dramatic-sounding diagnosis that had already created a sense of fear and hesitancy about loading the foot. This is a perfect example of how imaging findings—especially without proper clinical correlation—can lead both the patient and clinicians down the wrong path.
Upon evaluation, the team found discrepancies between the diagnosis and the patient’s actual presentation. There was no history of trauma, no acute “pop” or swelling, and the foot demonstrated reasonable strength and stability. Instead, what became clear was that the athlete had a chronic case of plantar fasciopathy, worsened by gait mechanics and loading errors during sport.
Through patient education, load management, soft tissue therapy, and progressive strengthening, the athlete was able to return to play within weeks—without the need for immobilization, injections, or surgical consults. The key takeaway? Imaging is a tool, not a truth. It should support, not replace, thoughtful clinical reasoning. When we put too much stock in scary-sounding imaging reports, we risk over-medicalizing manageable conditions—and slowing the patient’s return to function.
Case 2: A Classic Pars Fracture in a Young Athlete
The second case involved a high school athlete with persistent low back pain during extension-based movements, especially while sprinting and during overhead lifting. The athlete had been treated conservatively for months under a non-specific low back pain label, but symptoms never fully resolved. Once evaluated at The FARM, the clinical signs pointed clearly to a potential pars interarticularis stress injury.
The team moved swiftly but cautiously: bracing, rest from aggravating movements, and a thorough rehab plan focused on core stabilization, segmental control, and slow reintegration of load through the posterior chain. Confirmatory imaging revealed a classic unilateral pars defect, validating the suspicion—but not changing the conservative game plan.
What stood out in this case was the balance between knowing when to refer for imaging and how to avoid letting the imaging drive fear. The athlete not only recovered fully but returned stronger than before, with an improved understanding of spinal mechanics and core function.
Both cases reveal a core principle at The FARM: Clinical excellence lives at the intersection of science, intuition, and human connection. When imaging is used responsibly, when diagnoses are questioned with curiosity, and when patients are treated with the expectation of healing—not fragility—outcomes improve dramatically. This week’s podcast is a compelling reminder that the best medicine often comes from listening, observing, and believing in the body’s ability to recover.
