Injury blog: Plantar fasciopathy

It’s morning, and the alarm clock has just told you it’s time to get out of bed. Another few minutes won’t hurt. You check your emails, social media sites, and even ring mum to see how the dog slept last night… basically anything to delay putting your feet on the ground and taking those first steps to get the day started. And it’s because of this pain you’ve been getting on the bottom of your heel every morning for the last few weeks. And it’s getting worse… time to see your osteopath!

There are a few things that can cause pain on the bottom of the heel, but the most common cause is a condition named plantar fasciopathy (pronounced ‘fash-ee-op-a-thee’ — previously known as plantar fasciitis (pronounced ‘fash-ee-i-tis’)). There are many other conditions very closely related to this or overlapping with this and it may mean the standard treatment or stretches don’t work for you.

What is plantar fasciopathy?

Plantar fasciopathy is an overuse condition affecting the plantar fascia. The plantar fascia is a layer of soft tissue that stretches along the bottom of the foot, from the heel bone to the metatarsal bones in the front of the foot. It helps to provide stability to the arch of the foot and is similar in make-up to a tendon (the things that attach muscle to bone). If too much stress is placed on this structure, over time the tissue can degenerate, weaken, and start to give you pain. The pain is commonly felt where the plantar fascia attaches into the heel bone.

Risk factors

Scientific research suggests there are a few groups of people who are more prone to developing plantar fasciopathy. These include:

• Runners
• People who are overweight and lead a sedentary lifestyle and/or spend long periods standing for work (e.g. a factory worker)

Important things to consider with these at-risk groups include:

• Foot alignment and arch height: Having a very low or high arch or having excessive or not enough movement in the foot joints may lead to the development of this problem.
• Amount of training: Increased levels of training may place greater stress on the plantar fascia more regularly.
• Footwear: Wearing certain types of footwear when training may lead to an increased risk of plantar fasciopathy (i.e. wearing athletics spikes, or the wrong footwear for your foot type).
• Muscle strength and flexibility: Decreased strength in the muscles that control toe movement, as well as weakened and tight calf, hamstring and gluteal muscles are all associated with higher rates of plantar fasciopathy.

Personally I’ve found weaker calves, or a sudden increase in load are the two most common causes. This may be a change in activity (e.g. after a break), starting a new sport , and change in footwear.

Signs and symptoms of plantar fasciopathy

The signs and symptoms of plantar fasciopathy include:

• Pain at the bottom of the heel or arch
• A gradual onset of pain initially, but can be sharp and sudden once it’s there
• Feeling pain first thing in the morning (i.e. taking those first steps out of bed in the morning is classic!)
• Pain that decreases with activity, but increases again afterwards (early stages)
• Pain that increases with activity and pain felt at night (latter stages)
• Periods of prolonged rest during the day causing pain (i.e. being sat at your desk for 2-3 hours and then getting up again)
• Tight foot, calf, hamstring and gluteal muscles
• Weak muscles that help to support the arch of the foot
• Stiff or over-flexible foot and ankle joints

Diagnosis and treatment

First things first, if you have heel pain that sounds similar to the picture we have painted above, make an appointment with us (you know what to do… call us on 9846 2800). Once we have asked the relevant questions, performed the necessary tests, and we are in agreement that the issue stems from the plantar fascia, we will formulate a plan with you with short and long-term goals to reach within a set time.

Initial hands-on treatment will include a combination of massage, joint mobilisation and manipulation, and sometimes dry needling of the lower limb muscles with the aim of assisting any mechanical issues that are playing a role in this issue. Depending on the presentation, we may also use tape around the foot and ankle to provide support and reduce the stress being placed on the tissues. Other treatment will include advice on weight loss (if required), training regimen, footwear, and exercise prescription that helps to lengthen and strengthen tight and weak muscles. Some cases of plantar fasciopathy may require a foot orthotic or in-sole to provide extra support to the foot whilst wearing shoes. We may advise on footwear too! 

Plantar fasciopathy is a tricky condition to treat which may require ongoing treatment for several months, but we like do things quickly if possible. We will endeavour to get you pain-free in the shortest time possible, so we recommend following all advice to a T, which may include a reduction in the amount of training you are doing at present allowing for a gradual build up. When you start to hit goals and we see improvements being made, we’ll have you back up to your full training program before you can say “plantar fasciopathy”.

Imaging?

People regularly ask if they need imaging for such an issue? The majority of cases may be diagnosed through case history and physical assessment. This is where we excel! Imaging is there for cases that do not respond to treatment and for those instances where we need to rule out a more serious problem.

If you need help with heel pain, please call us today on 9846 2800 to book your appointment. We are located in Donvale, Templestowe and Warrandyte. Let’s have you putting your best foot forward, ASAP! 👌

References

1. Thompson, JV. et al. 2014. Diagnosis and management of plantar fasciitis. Journal of American Osteopathic Association. 114 (12). Available from: https://jaoa.org/aoa/content_public/journal/jaoa/933660/900.pdf
2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
3. Harvard Health Publishing. 2007. Easing the pain of plantar fasciitis. [Online]. Available from: https://www.health.harvard.edu/newsletter_article/Easing_the_pain_of_plantar_fasciitis. [Accessed 15 Jul 2020]
4. Orthoinfo. 2010. Plantar fasciitis and bone spurs. [Online]. Available from: https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs. [Accessed 15 Jul 2020]