Plantar fasciopathy

Background:

Plantar fasciopathy is the most common cause of plantar heel pain with an estimated prevalence of 4-7%.

This condition was previously known as plantar fasciitis but given the traits it has in common with a tendinopathy the term "fasciopathy" is now recommended.

The plantar fascia is a strong, but flexible, fibrous band connecting your heel bone (calcaneus) to your toes (fig. 2) and it serves as a shock absorber and a structural support to your foot each time weight is placed on it.

 Figure 1: The plantar fascia, highlighted in green.

Figure 1: The plantar fascia, highlighted in green.

 

Symptoms:

The origin of the plantar fascia on the calcaneus, as well as some components of the fascia, can become irritated and thickened with overuse causing tenderness and pain in the local area, classically the infero-medial aspect of the heel (fig. 2).

 Figure 2: Irritation and micro tears to the plantar fascia calcaneal insertion.

Figure 2: Irritation and micro tears to the plantar fascia calcaneal insertion.

 

Often the pain is worst first thing in the morning or after periods of activity. Typically these symptoms are gradual in onset and there are several factors which can increase the risk of getting plantar fasciopathy.

 

Risk factors:

It commonly affects very active people, such as runners, as well as those who may have high amounts of standing occupational work. Other risk factors include:

  • varus knee alignment (bow-legged)
  • use of spiked athletic shoes 
  • cavus foot posture (high inner arches)
  • increased training volume
  • most likely linked to high body mass index (BMI)

 

What to do about it:

The most important thing to do first is to minimise the aggravating activity. If the symptoms have been present for a sustained period of time then some Physiotherapy treatment would be advisable. Treatment of plantar fasciopathy includes using taping methods and shoe inserts (to offload the painful area), stretching techniques and soft tissue therapy. There may be several other facets to treatment if other problems like tight calf and hamstring muscles, or stiff ankle joints are thought to have contributed.

If sport is important to you but is what brought on your symptoms then a phased return to the activity when things have settled down is very prudent. This would also be the case for standing work and limiting the number of hours on your feet is a good way to ensure graded exposure to the plantar fascia.