Plantar Fasciopathy (Heel Pain)

Plantar Fascia

Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.

What is Plantar Fasciopathy

Plantar fasciopathy is believed to have a mechanical nature of onset whereby failure of the plantar fascia supporting the loads applied to the foot is the cause. Injury to the plantar fascia can be acute or chronic and is thought to result from chronic overload from either lifestyle or exercise. Whilst acute tears of the plantar fascia can occur in runners and jumpers, the most cases are due to progressive and chronic overload.

Plantar fasciopathy is one of the most common causes of plantar heel pain in both runners and non-runners, with 10% of people experiencing plantar fasciopathy across their lifespan. Plantar fasciitis affects both sedentary and athletic people.

Signs & Symptoms

• Pain & tenderness on the medial aspect of the calcaneus (medial calcaneal tubercle)
• Morning pain that can last from the first few steps to minutes or longer
• Ache or stiffness that increases with rest following activities including excessive walking or running (especially uphill, on uneven surfaces), jumping, hoping or activities involving repeated change of direction.
• Pain that warms up with activity (initial stages of the condition)
• Pain with heel raises (going up on the toes)
• Increased pain and stiffness in the heel for 24 hours after exercise (ie. The next morning)

Risk Factors

• Being overweight
• Age – middle aged or older
• Certain population groups
  • Runners or those whose activity involves lots of jumping (ballet, dancing)
  • Occupations requiring prolonged standing (factory workers, teachers)
• Poor foot biomechanics (can be flat & high arched feet)
• Tight calf muscles
• Joint stiffness in the foot and ankle, hip & knee
• Inappropriate training loads (training surface, poor recovery or too quick an increase in intensity or duration)
• Inappropriate footwear
• Following acute ankle trauma, fractures of the ankle or chronic ankle instability

Physiotherapy Management

• RELATIVE rest from aggravating activities (complete rest is actually detrimental to tendon remodelling)
• Swelling and pain management = ice, massage, dry needling, taping
• Bracing or taping to offload the tendon
• Heel raises or wedges to unload the tendon
• Progressive rehabilitation program including
  • Stretching
  • High load strengthening exercises
  • Joint Mobilisation and manipulation
  • Proprioceptive exercises
• Assessment of running technique and implement strategies to improve Running Biomechanics
• PROGRESSIVE TENDON STRENGTHENING PROGRAM (The Gold Standard Treatment)
• Structured Running program focusing on appropriate loading principles

Adjunctive Treatment Options 

• Shockwave therapy
• Anti-inflammatory advice
• Orthotics prescribed by our ModPod Podiatrists
• CSI if a tenosynovitis is present
• Platelet-Rich-Plasma (PRP) Injection

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