Plantar fasciopathy, also known as plantar fasciitis, is a common cause of heel pain. The pain affects the band of tissue known as the plantar fascia that runs from the heel to the toes on the base of the foot (see figure 1). The injury process is considered similar to tendon injuries/tendinopathies (hence the “fasciopathy”), with degenerative changes more causative than inflammation (thus moving away from plantar fasciitis as a term) (2).
Plantar fasciopathy often occurs insidiously. The pain is common with the first few steps in the morning or after prolonged sitting, also worsening at the end of the day or end of long periods of activity (e.g. end of a walk or run). It is not uncommon to occur in both feet (up to 1/3 of people with plantar fasciopathy) (2). This type of pain can occur in active and sedentary individuals, however typically is more common in older populations. The condition can affect up to 10% of the population over their lifetime, and is common in runners, accounting for up to 8% of all running injuries (2, 3).
Risk factors for plantar fasciopathy (2, 3, 5, 8) are displayed visually in figure 2, and can include:
Age: older age causes increased planter fascia degeneration, a thicker heel pad, and decreased fascial elasticity, leading to reduced shock absorption.
Obesity: thought to worsen the microtrauma in the plantar fascia, with constant overload affecting healing/repair and causing increased degeneration. The causes a thicker heel pad, decreased fascial elasticity and shock absorption.
Biomechanical: increased foot pronation (foot rolling in) can cause increased fascial tension during the standing component of gait (stance phase). Reduced ankle dorsiflexion (upwards ankle movement), foot arch height and heel strike in running are also linked.
Footwear: inappropriate or hard footwear will often increase risk.
Occupation: prolonged weightbearing/standing during work, repetitive jumping in or out of a truck, and standing on hard surfaces.
Training Load/Error: rapid changes in training sessions, intensity, volume or technique (load/overuse) increase the risk. Running/walking on hard surfaces is also linked with increased risk.
Sport: common in running, whilst jumping sports have an increased risk.
Others: increased calf and hamstring tightness have some links, whilst gender and genetics are inconclusive. Heel spurs have inconclusive evidence to support a link with increasing risk of plantar fasciopathy.
Management for plantar fasciopathy often varies between individuals depending on the contributing factors. Recent evidence has strongly advocated for completing high load strengthening exercises for the plantar fascia, with results showing significantly higher levels of improvement compared to isolated stretching (6). Use of orthotics, taping, stretching and massage/manual therapy all provide some benefit and can be included along with the strengthening exercises (3). Shockwave therapy may provide additional benefit for pain relief (7). Consult your physiotherapist or podiatrist regarding the best management for your heel pain. If you have a number of the aforementioned risk factors, it may be advisable to consider a preventative program. Positively, research shows that up to 90% of cases will resolve within 12 months if managed with appropriate care (e.g. physiotherapy directed rehabilitation) (8).
A rehabilitation exercise that has been proven to improve plantar fascia pain can be found on my Instagram channel here, or in the youtube video below (Ky Wynne Physio Youtube Channel).
References:
1. Figure 1: Picture source: https://www.docpods.com/plantar-fascia-anatomy
2. Beeson, P. (2014). Plantar fasciopathy: revisiting the risk factors. Foot and Ankle Surgery, 20(3), 160-165.
3. Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., & Davis, I. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.
4. Figure 2: Picture source: https://www.instagram.com/kywynnephysio/
5. Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). Risk factors for plantar fasciitis: a matched case-control study. JBJS, 85(5), 872-877.
6. Rathleff, M. S., Mølgaard, C. M., Fredberg, U., Kaalund, S., Andersen, K. B., Jensen, T. T., ... & Olesen, J. L. (2015). High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian Journal of Medicine & Science in Sports, 25(3).
7. Ibrahim, M. I., Donatelli, R. A., Hellman, M., Hussein, A. Z., Furia, J. P., & Schmitz, C. (2017). Long‐term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo‐controlled trial with two years follow‐up. Journal of Orthopaedic Research, 35(7), 1532-1538.
8. Monteagudo, M., de Albornoz, P. M., Gutierrez, B., Tabuenca, J., & Álvarez, I. (2018). Plantar fasciopathy: a current concepts review. EFORT open reviews, 3(8), 485-493.
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