Understanding Plantar Fasciitis - Plantar Fasciopathy - Plantar Heel pain  

Heel Pain, commonly known as Plantar Fasciopathy or Plantar Fasciitis, is a persistently frustrating condition that can affect individuals across various lifestyles, from office workers and walkers to avid runners. This ailment manifests as pain underneath the foot's arch, often linked to environmental stress—such as prolonged standing at work—or mechanical factors, like a sudden increase in running volume.

Affecting 4-7% of the population and contributing to 8% of running-related injuries, Plantar Fasciopathy exhibits a higher incidence in the 40-60 age range, particularly among sedentary individuals with a higher BMI. Females, on average, experience a more extended prognosis.

Risk Factors

Several factors contribute to the development of Plantar Fasciopathy, including:

  • Recent spikes in running volume, intensity, frequency or change in terrain

  • Changes in footwear

  • Prolonged standing

  • Inadequate recovery.

  • Reduced ankle and great toe mobility

  • Insufficient foot strength

  • Limited Achilles tendon stiffness

Clinical Presentation

The condition presents as pain under the foot arch, with tenderness, especially in the morning. Other symptoms include pain that warms up with exercise but returns upon cessation and discomfort after extended sitting or rapid movements.

Prognosis

Plantar Fasciopathy can be settled down in 6-12 weeks for some individuals, while others may still experience symptoms at 1 year. On average, the prognosis is around 13 months, emphasising the variable nature of this condition. Early and aggressive offloading strategies significantly impact improvement.

Management Strategies

Key to managing Plantar Fasciopathy is immediate and aggressive offloading. This can take various forms based on the severity of symptoms and their impact on the plantar fascia.

Taping, orthotics, and a change of footwear serve as effective short-term measures to alter the load through the foot, providing relief and calming down foot and heel pain. While not a long-term solution, these interventions often serve as a starting point.

Once symptoms have settled, management involves:

Improve Mobility:

Dynamic movements and stretching target mobility of the calf muscles, ankle, and big toe,

Loading or Strengthening:

Strengthening exercises for the foot and calf

Plyometrics:

Facilitate the ‘Windlass mechanism’ of the foot

Steroid Injections:

Caution is advised, and steroid injections are not recommended until after 3-6 months of quality rehabilitation have been undertaken. Cortisone has been shown to reduce short term pain but doesn’t seem to add anything in the long term

Get Professional Help

We have physiotherapy clinics in Clovelly, Coogee, and Manly, as well as in London, so come and see us in person or if you are anywhere in the world, access us via an online physiotherapy consultation that we have specifically developed to assess and treat runners anywhere in the world with great success.