Plantar Fasciopathy

Plantar fasciopathy is the most common foot injury. It is more commonly known as plantar fasciitis however more is known about this painful condition. Plantar fasciopathy: is a generalised blanket term used to describe a long term overuse problem of the plantar fascia that causes heel pain. Plantar fasciopathy includes the two phases of damage which are the inflammation phase (plantar fasciitis) and the non inflammation phase (plantar fasciopathy). The role of the plantar fascia is to provide the foot with an arch. It also asks as an internal spring within the foot. During walking the plantar fascia goes through a constant process of tightening and relaxing known as the windlass mechanism.

In the early stages of injury the plantar fascia may become inflamed. The inflammation can be due due to micro tears within the plantar fascia at its origin at the calcaneus. The classic symptom is pain with the first steps getting out of bed. These micro tears are caused by overload to the tissue. This overload can be caused by a number of factors. One of the most common is a sudden change in activity level such as taking up weight bearing exercises that the fascia is not prepared for (i.e. running, step aerobics etc.) Another common cause is an increase in body weight leading to more pressure on the fascia.

If pain persists after the inflammatory stage the patient is more than likely dealing with a plantar fasciosis. Plantar fasciosis is the term used to describe heel pain caused by the degeneration (deterioration) of the plantar fascia which often occurs as a result of repetitive stress. This pain is more likely to be ongoing with little changes in the pattern of pain from day to day. This pain is more likely to occur after rest or after sitting etc. Due to the deterioration in strength of the plantar fasciia from long term damage. the plantar fasciia becomes easier to damage and thus a more prone to becoming re-inflammed (plantar fasciitis) and thus people often end up going through cycles of inflammation.

There are a variety of treatments that are used to treat this problem. One important factor to consider with treatment is the length of time you have had the pain. This can determine whether you are in the acute stage or chronic stage (fasciitis or fasciosis as described above). The stage that you are in changes the treatment approach. During the acute stage, taping of the foot is important in order to off load the injured fascia. Taping is performed until pain in the heel is reduced in the morning. Once pain subsides soft tissue manipulation of the fascia is used in order to reduce possible scar tissue in the fascia. Manipulation of the joints within the foot is also important in order to restore any lost motion within the foot. Joints within the foot commonly manipulated include the talocrural and subtalar joint.

Finally, an exercise program is prescribed to stretch the calf and plantar fascia on a daily basis.

I am often asked if orthotics are required for plantar fasciitis. The research indicates that orthotics are not always necessary. There have been studies demonstrating that an off the shelf orthotic is just as effective as a custom orthotic in patients with plantar fasciitis. The first step is to modify footwear and make sure that you are wearing a supportive shoe. If this does not help I will then recommend an off the shelf orthoitc such as a Vasyli or Sole. If this fails then a custom orthoitic can be prescribed.

As you can see the treatment of plantar fasciitis is complex. It is much more than the use of TENS and ultrasound. Your treatment should be based on a case by case basis following a detailed examination performed by a physiotherapist.