Injuries Unpacked #13: Plantar Faciopathy

Plantar fasciopathy is one of the most common causes in heel pain (1).  Though previously termed ‘plantar fasciitis’, due to patient presentation and pathological changes in tissue structure similar to those of tendinopathies, longstanding plantar fasciopathy is now considered a tendinopathy (2). 

The plantar fascia is a thick, weblike connective tissue which supports the arch of the foot. The plantar fascia plays an important role in the normal biomechanics of the foot, where it provides shock absorption during walking, running and jumping. Plantar fasciopathy is the result of overuse irritation of the plantar fascia origin at the calcaneal tuberosity of the heel bone (3).

The condition is characterised by severe and well-localised pain that can hang around for many months, or even years (5). People with plantar fasciopathy usually complain of sharp, shooting pain in the heel during the first barefoot steps out of bed in the morning; which may improve with moving around. Typically, symptoms are worse after exercise. Pain can also be triggered by long periods of standing or when you get up after sitting. Runners and 40-60-year-old people with low activity levels and a high body mass index (BMI) are the most susceptible to plantar fasciopathy (6). Reduced ankle range of movement, excessive arch collapse, improper fitting shoes, and diabetes are other risk factors that may also contribute to heel pain associated with plantar fasciopathy (7). The condition is slightly more common in females and can occur in one or both feet simultaneously.

During examination, your Physiotherapist will observe the shape of your foot/feet and watch how you walk without shoes on. Additionally, your Physiotherapist will perform a number of tests to confirm a diagnosis of plantar fasciopathy. Pain is likely to be reproduced by palpating the origin site at the heel bone and can be confirmed by a positive Windlass Test; whereby symptoms are reproduced by flexing the big toe back, putting the plantar fascia on maximum stretch. 

To watch an example of the physiotherapy assessment of Plantar Fasciopathy, click the link below.

Conservative physiotherapy management is considered to be effective at managing symptoms of plantar fasciopathy. Traditionally, treatment has included stretching, gel inserts into shoes and corticosteroid injections. Increased research now supports the use of exercise and load to treat plantar fasciopathy. Rathleff et al (2014) explored plantar fascia-specific training that consisted of slow, high-load strength training in people with diagnosed plantar fasciopathy. Participants performed heel raises with a towel underneath the toes to increase toe joint range. The authors found that slow, high-load strength training in addition to gel heel inserts was superior to plantar fascia-specific stretching with heel inserts after 3 months. 

Another study by Kongsgaard et al (2009) compared two strength training programs to a non-exercise group who received a corticosteroid injection. Both strength programs were found to be more therapeutically beneficial regarding pain and function to the steroid injection group at the end of the study. Furthermore, heavy and slow resistance strength training was associated with more normalised tissue structure changes in the plantar fascia overtime. 

If you are experiencing significant heel pain come into SportsTec Clinic and have one of our Physiotherapists assess you. 

References

  1. Landorf KB. Plantar heel pain and plantar fasciitis. British Medical Journal Clinical Evidence, 2015; 2015: 1111. 
  2. Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine, 2016; 50: 1187-1191.
  3. Riel H, Cotchett M, Delahunt E, et al.  Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. British Journal of Sports Medicine, 2017; 51: 1576-1577.
  4. Plantar Fascitis. Photo accessed from: https://cfo.com.sg/our-sub-specialites/centre-for-foot-and-ankle-surgery/plantar-fasciitis-heel-pain/
  5. Hansen L, Krogh TP, Ellingsen T, et al. Long-Term prognosis of Plantar Fasciitis: A 5- to 15-year follow-up study of 174 patients with ultrasound examination. Orthopaedic Journal of Sports Medicine, 2018; 6(3): 1-9.
  6. van Leeuwen KDB, Rogers J, Winzenberg T, et al. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. British Journal of Sports Medicine, 2016; 50: 972-981.
  7. Waclawski ER, Beach J, Milne A, et al. Systematic review: plantar fasciitis and prolonged weight bearing. Occupational Medicine, 2015; 65(2): 97-106. 
  8. Windlass Test. Photo accessed from: https://www.youtube.com/watch?v=fg0PtnoAzSs
  9. Rathleff MS & Thorborg K. ‘Load me up, Scotty’: mechanotherapy for plantar fasciopathy (formerly known as plantar fasciitis). British Journal of Sports Medicine, 2015; 49(10): 638. 
  10. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medical Science and Sports 2009; 19: 790–802.