Plantar Fasciopathy / Plantar Fasciitis

Daniel Reeves (Physiotherapist – Burnie)

Plantar fasciopathy (PF), sometimes referred to as plantar fasciitis is an overload/overuse condition that is characterized by pain in the heel and foot. It also involves structural changes such as thickening & degenerative changes, most commonly at the insertion of the plantar fascia into the heel bone.

The term fasciopathy is now considered more accurate than the more common term fasciitis, as fasciitis implies an inflammatory process which is less commonly seen (compared to the structural changes described above).

The plantar fascia is a band of connective tissue running from the heel to the front of the foot along the sole. The plantar fascia functions to keep the bones and joints stable and strong to enable a good push off the ground during activity such as walking, running and jumping.

The cause of PF is multifactorial. A reduction in ankle joint range of motion, especially reduced ankle dorsiflexion has been suggested as a major risk factor for development of chronic PF.

PF like many other overload/overuse conditions, can develop due to an acute or chronic periods of overload. This is where you have done too much too soon or as a result of high loading over a period of time. In either scenario, you have exceeded the capacity of your plantar fascia to withstand the load placed on it. Inadequate recovery between loadings may also be a contributing factor.

Symptoms

If you have PF you may experience:

• Sharp pain at the inside part of the bottom of the heel when first walking in the morning (or after periods of rest) that improves after a period of walking
• Pain that is worse at the end of the day
• Pain with prolonged standing
• Pain with sport and impact activities, e.g. running or jumping

Modifiable Risk Factors (things you can change)

• Body weight: overweight or obese people have a 1.4x increased probability of suffering chronic PF
• Lifestyle/Occupation: due to this being primarily an overload condition, poor management of exercise or workload is a risk factor.
• Calf tightness: there is some evidence to suggest that tight calf muscles are a major risk factor

What About Heel Spurs?

Currently the evidence suggests that there is no association between heel spurs and suffering PF.

PF is most common in people 45-65yrs but can affect any one at any stage of their life.

Treatment

The aim of treatment is to reduce pain and improve strength, flexibility, load tolerance and function.

About 90% of cases will resolve within 12 months without the need for surgery.

Education around correct load management will form a large portion of treatment.

When you have PF the load encountered is too large for your current strength/capacity. Your plantar fascia is unable to tolerate the load you are putting on it. Learning how to gradually increase load and strength/capacity and when to take is easy is an important component of physiotherapy for this condition.

Exercises and stretches to improve your symptoms will form a primary component of treatment. Common exercises prescribed include calf raise variations, self-release of surrounding musculature, exercises to strengthen the foot and stretches for the plantar fascia.

Your Physiotherapist may also teach you how to tape your foot to help relieve pain and reduce load on the affected area.

Strategies to reduce weight if overweight/obese can also be beneficial as less weight equals less load on the plantar fascia.

What about Orthotics?

Orthotics can be helpful to reduce load on the plantar fascia. Currently the evidence shows no significant difference in pain relief at 12 month follow up between over-the-counter shoe inserts and customized shoe inserts.

What about Splints?

Night splints are often worn to stretch the fascia to prevent morning soreness. There is some evidence that these can be helpful but they should be used in conjunction with load management education, exercise and not be the primary or sole treatment.

What about Injections?

Outcomes from injections of corticosteroid or local anesthetics vary for each individual. Having multiple injections can even increase the risk of rupture of the plantar fascia. Of the studies completed on injections for PF, there is low quality evidence of a positive short term effect with it lasting only 1 month.

The best thing you can do?

Come and see one of our Physiotherapists either in Burnie or Somerset. Despite the potential for PF to recover slowly, our Physiotherapists are highly trained to support you and your condition and get you back doing what you want without pain or restriction. Often a course of general strengthening may be required, so that you have greater strength elsewhere to distribute weight-bearing loads more effectively. For this reason seeing an Exercise Physiologist can at times also be recommended.

If you would like to get in touch with us, please phone our Burnie office on 64314586.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134886/

https://sma.org.au/resources-advice/injury-fact-sheets/plantar-fasciitis/