Plantar Fasciopathy
The Highlights
The plantar fascia is a thick tendon-like band of connective tissue running from the heel to the toes. Plantar fasciopathy is an extremely common overload injury to this structure.
It’s more commonly known as “plantar fasciitis” but we try to avoid this term because “itis” means inflammation and we now know that isn’t what matters.
Pain at the heel and/or into the arch (especially when first standing from rest) are the most common symptoms.
Although common, many people struggle with this condition for a long time - it doesn’t have to be that way!
In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound.
Evidence-based treatment includes taping, foot orthoses (specialist insoles), footwear advice and progressive loading exercises. And when the condition is more chronic (more than a couple months), extracorporeal shock wave therapy (ESWT) can be a game-changer.
What is it and what are the symptoms?
Plantar Fasciopathy is an overload injury to the plantar fascia - a thick band of tissue that joins your heel to the base of your toes and acts as one of the key load-bearing structures of your arch. It is one of the most common conditions we treat in our practice.
Plantar fasciopathy symptoms usually involve pain (which can vary from mild to severe) at the plantar surface (sole) of your heel and/or pain into the arch of your foot. The pain is often worse when first standing up from a rested state (getting out of bed in the morning for example) which tends to ease after moving around only to worsen again at the end of the day. The pain can be a dull ache or a sharp stabbing pain and may also feel burning. If you have nerve-type pain like zapping and tingling you might have a nerve entrapment in the area (which we can help diagnose) rather than true plantar fasciopathy.
Why does it happen?
Plantar fasciopathy is an overload injury - in essence, the amount of mechanical load or stress the plantar fascia can take on a daily basis has been exceeded too many times for it to keep up with healing and adapting.
Symptoms often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a are particularly at risk), a change in shoes and weight-gain are all risks.
We also know that factors like poor sleep and emotional and psychological stresses can all play an important role.
What are the treatment options?
Once the diagnosis of plantar fasciopathy is confirmed (usually through physical examination but this may also include the use of diagnostic ultrasound), we can make a treatment plan. This will be tailored to you based on some of the factors above that may need addressed.
Key amongst these is offloading the injured tissue to give it the opportunity to heal - taping and foot orthoses (specialised insoles) are both incredibly helpful for this (as a side, we do not recommend patients buy cheap flimsy over-the-counter insoles that promise to help heel pain as these devices are next to useless).
Between this and correct footwear (very important) we can then look at a rehabilitation programme designed to give the plantar fascia the necessary stimulus to repair and also to strengthen the muscles that aid it's function.
In most cases, we find these steps will be enough to eventually resolve the problem. Where pain persists or needs to be tackled quickly for a big event coming up, we will recommend extracorporeal shock wave therapy (ESWT). This advanced technology is clinically proven to accelerate healing and reduce pain, and has been approved for use in plantar fasciopathy by the National Institute for Health and Care Excellence (NICE).
