Heel pain: Plantarfasciopathy (“Plantar fasciitis”)

Plantarfascia

Plantar heel pain (pain on the sole of the foot, at the heel), of all origins, accounts for approximately 12% of all MSK conditions, affecting about 10% of the population. While there are several causes of plantar heel pain, plantarfasciopathy, once called “plantar fasciitis”, is probably the most common cause. The old name has now fallen out of favour as imaging studies have shown little or no inflammation as part of this condition (“-itis” means inflammation; “-opathy” means pain).

Plantarfasciopathy is a condition involving mild to severe pain as a result of injury to the plantar fascia. The plantar fascia is a thick, fibrous band of collagenous connective tissue originating at the medial tubercle of the calcaneus (heel bone) and extending to the metatarsal heads and proximal phalanges of the toes. Its principle roles are to support and stabilise the medial longitudinal arch and to assist proper dorsiflexion of the hallux (big toe) during the propulsive phase of gait through the “Windlass Mechanism”. The pain in plantarfasciopathy tends to gradually increase over time, is worse when first standing in the morning, when standing after having been seated or lying down for a period of time, or after long periods of standing or walking. Plantarfasciopathy mostly occurs unilaterally (one foot only), although as many as 30% of people with the condition may experience pain bilaterally (both feet).

Risk factors for developing plantarfasciopathy include: “overuse” (accumulated loads higher than the tissue can accommodate without injury), excessive subtalar joint pronation and reduced medial longitudinal arch height (flat feet), anything leading to a dysfunction of the Windlass Mechanism, high BMI, trauma to the plantar fascia with insufficient rest after injury, and rapid transition from high heels to flat shoes.

Alternative diagnoses are: plantar calcaneal spur (heel spur); entrapment of the lateral plantar nerve and its first branch; tear or rupture of the plantar fascia; calcaneal stress fracture.

Podiatry treatment can include heel pads or heel raises, off-the-shelf or bespoke in-shoe orthotic devices (“medical grade insoles”), night splints (if used with other treatments), stretching, therapeutic strapping, acupuncture, corticosteroid injections, Shockwave Therapy, and surgery in severe cases that do not respond to conservative treatment.

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