Heel Pain? It might be Plantar Fasciopathy. Part one.
Plantar Fasciopathy (commonly known as Plantar Fasciitis) is a condition that presents with pain under or around the heel. It is one of the most common causes of pain around the foot, and this blog is here to unpack the diagnosis, causes and treatment of Plantar Fasciopathy.
Note! Plantar Fasciopathy is commonly known as Plantar Fasciitis. These are interchange terms for the same condition. Historic literature has suggested an inflammatory element to the condition, whilst newer research has indicated there is not the inflammatory process as previously thought (1). As such, for the remainder of the blog, I will be referring to this troublesome condition as Plantar Fasciopathy.
What is Plantar Fasciopathy?
Plantar Fasciopathy is pain that originates from the Plantar Fascia. The Plantar Fascia is a tendon-like structure that inserts into the calcaneus (heel bone) and attaches into the base of the toes. The Plantar Fascia exhibits elastic properties which allows it to aid in shock absorption, energy storage and return of energy. The Plantar Fascia acts in a very similar fashion to the Achilles Tendon.
How common is Plantar Fasciopathy?
Plantar Fasciopathy is one of the most common causes of foot pain. It has been suggested that one in ten people will experience Plantar Fasciopathy in their lifetime (2). Although Plantar Fasciopathy can present at any age, it more commonly occurs between the ages of 30-60.
What are the symptoms?
Plantar Fasciopathy does have common symptoms which includes (3):
Pain and stiffness in the heel or arch upon first steps taking after sleep or resting.
Soreness to touch at the medial or plantar aspect of the calcaneus (heel bone).
Pain and stiffness that ‘warms up’.
Increased pain and stiffness within a 24 hour period following bouts of exercise such as walking, running and sport.
What causes Plantar Fasciopathy?
The cause of Plantar Fasciopathy is multifactorial. There is thought to be a mechanical element, whereby any increase in load, if greater than the capacity of the Plantar Fascia tissue, can cause symptoms. If you’d like to learn more about load versus capacity, check out our blog here.
Examples of increases in load can include:
Increased daily step count
Returning to running
Change of surface for exercise or work
Introduction to a new type of exercise
Plantar Fasciopathy can begin without any marked changes to load. There are also some known risk factors which can place you at higher risk of developing Plantar Fasciopathy (3):
Limited ankle joint dorsiflexion range of motion
Higher levels of running based activity
Higher body mass index
Work-related time spent on feet (ie time spent standing on hard surfaces or walking)
Foot biomechanics - the way your foot functions during gait can increase the load on the Plantar Fascia
What else could it be? (differential diagnosis)
Plantar Fasciopathy is one of many plantar heel pain presentations. Given the complex nature of the foot, there is a range of other pathologies that can present at the heel. Some other diagnoses includes:
Fat Pad Syndrome: The heel fat pad is located in very close proximity to the insertion of the Plantar Fascia. It is an important structure of the foot as it functions as a cushion to aid in shock absorption and distribute force during walking or running. It is suggested that it may be the second leading cause of plantar heel pain (behind Plantar Fasciopathy) (4).
Tarsal Tunnel Syndrome (TTS): TTS is a local compression of the Posterior Tibial Nerve, which can occur due to biomechanical variation, local inflammation of surrounding tissue, or lesions occupying the space (such as ganglions). It presents with symptoms of tingling, burning or numbness in the medial aspect of the ankle, which can radiate to the plantar aspect of the foot (5).
Baxter’s Nerve Impingement: Baxter’s Nerve Impingement is the compression of a lateral branch of the plantar nerve. It can present with symptoms that mimic Plantar Fasciopathy due to the pathway of the nerve. It is suggested to account for up to 20% of plantar heel pain (6).
Calcaneal stress fracture: A Calcaneal stress fracture is a stress related response due to repetitive overload of the heel. It presents with pain during weight bearing activities and the pain often extends into rest. Calcaneal stress fractures require investigations such as MRI to aid in diagnosis.
What are the treatment options?
There are many treatment options for Plantar Fasciopathy, which will be presented and guided by your practitioner at Foot & Ankle. Given the complex nature of the options - we’ve written another blog, you can find that here!
Want help diagnosing your heel pain? Book in here to see a Foot & Ankle Practitioner.
References
Lemont, H., Ammirati, K. M., & Usen, N. (2003). Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Journal of the American Podiatric Medical Association, 93(3), 234–237. https://doi.org/10.7547/87507315-93-3-234
Lopes, A.D., Hespanhol, L.C., Yeung, S.S. et al. What are the Main Running-Related Musculoskeletal Injuries?. Sports Med 42, 891–905 (2012). https://doi.org/10.1007/BF03262301
Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014;44:A1–33.
Chang, A. H., Rasmussen, S. Z., Jensen, A. E., Sørensen, T., & Rathleff, M. S. (2022). What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome. Journal of foot and ankle research, 15(1), 60. https://doi.org/10.1186/s13047-022-00568-x
Rodríguez-Merchán, E. C., & Moracia-Ochagavía, I. (2021). Tarsal tunnel syndrome: current rationale, indications and results. EFORT open reviews, 6(12), 1140–1147. https://doi.org/10.1302/2058-5241.6.210031
Chundru, U., Liebeskind, A., Seidelmann, F., Fogel, J., Franklin, P., & Beltran, J. (2008). Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot. Skeletal radiology, 37(6), 505–510. https://doi.org/10.1007/s00256-008-0455-2