Tomayto, tomahto; plantar fasciitis, plantar fasciopathy. For century’s terms such as gonorrhoeal heel, Policeman’s heel, jogger’s heel, plantar fasciitis and plantar fasciopathy have all been used interchangeably to describe pain under the heel. This reflects the evolving nature of our understanding of this condition.
Plantar fasciitis is often used as an umbrella term for heel pain issues but it’s not always technically accurate. Plantar fasciopathy is a more appropriate, modern terminology.
What’s the difference?
Plantar fasciitis refers to inflammation of the plantar fascia (‘itis’ in medicine means inflammation). Plantar fasciopathy is the overarching term for the condition, where plantar fasciosis refers to a phase in the condition when ligament tissues break down. (Plantar fasciitis (inflammation of the fascia) may occur in the initial stages of plantar fasciopathy.)
Does it matter what we call it?
‘Plantar fasciitis’ can be misleading because what we’re usually referring to is tissue degradation rather than an inflammatory condition. If we think inflammation, we may well treat it that way – take anti-inflammatory medications, use cold packs, rest up, have an anti-inflammatory steroid injection.
At present, many sufferers are having their half and full marathon dreams cut short, or perhaps giving up on those New Year resolutions activities due to heel pain. When they’re suffering from plantar fasciopathy, treating themselves for inflammation won’t help them to heal and get back on the road again. It’s really important to be given exercises and treatments that target the root cause of any pain in order to promote recovery. More accurate terminology helps us to understand why the pain is there and then how best to alleviate it.
Ok, what is plantar fasciopathy?
Plantar fasciopathy – as we should refer to it – is similar to tendon pathologies where it’s about load management and load capacity issues. It’s the overarching term for pain experienced in the heel of the foot, due to the plantar fascia taking excessive strain. The plantar fascia is a tough fibrous tissue on the bottom of the foot, providing support and helping us to propel forwards.
Who does plantar fasciopathy affect?
It can affect active and sedentary individuals and has a range of risk factors. Being overweight and having reduced flexibility in the ankle and big toe joints are the main risk factors. A sudden change or increase in physical activities have also been identified as major risk factors.
Often plantar fasciopathy develops when an individual increases their load, as a result of spending more time on their feet – and the plantar fascia – usually by running or walking more and across further distances. Symptoms appear when the plantar fascia fails to cope with this demand.
What are the symptoms?
Symptoms typically present as pain and stiffness in the bottom of the heel towards the inside of the foot. Pain is often worse in the mornings with the first few steps and after prolonged rest or activity.
Stage 1: The initial stage of plantar fasciopathy is a pain dominant stage. Characterised by early morning symptoms and reduced tolerance of daily activities/sport. The duration of this phase is variable and difficult to predict but may last up to 6-8 weeks.
Stage 2: Next is the load dominant stage where the plantar fascia is ready to take loading (graded specific exercises) to strengthen it. This stage can continue for 18 months but often isn’t painful.
The good news is that plantar fasciopathy does often get better with appropriate treatment and isn’t a self-limiting condition as previously thought. Indeed, the ‘watch and see’ approach may not be the best option – there’s a lot that can be done to help the condition and reduce the chances of its return.
Plantar fasciopathy treatment
It’s always best to have a thorough assessment by an appropriate clinician such as a physiotherapist. This is particularly important to help rule out other conditions affecting the heel and to understand why you got it in the first place. We can then help to ensure it doesn’t come back to bite you in the heel!
Stage 1 - Treatment at this stage is focused on settling the pain:
- Reduce the impact - If you’re suffering from heel pain, shock absorbing insoles reduce the load going through the plantar fascia and help reduce the pain you’re feeling.
- Rest the tissues - Avoid high activity and strain on the tissues surrounding the plantar fascia.
Stage 2 - At this stage it’s really important to do exercises to build full strength in the plantar fascia tissue:
- Stretch - Elongating the achilles tendon and plantar fascia helps to promote the correction position of the collagen fibres of the ligaments as they stitch back together.
- Apply warmth - When inflammation isn’t present, applying warmth to the heel, through a hot-water bottle or wheat bag, may bring relief and will help in the repair process.
Preventative measures
Better still, prevention is always better than cure:
- Wear shock absorbing insoles to limit excessive load going through the system and reduce your chances of getting injured in the first place from the word go. Don’t wait until you feel pain.
- Strengthening your foot is another method of reducing the load on your fascia and hence, your chances of getting this condition. There are a number of exercises that are designed to strengthen the foot. While care should be taken not to overexert the fascia, strengthening the muscles in the foot will improve its overall function and protect the fascia.
Robert Grainger MSc MCSP MHPC CSCS
Practice Principal PhysioFixx Physiotherapy
Sports Physiotherapist
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