Understanding plantar fasciopathy
Have you ever woken up in the morning to find that the first few steps you take out of bed cause excruciating pain underneath your heel?
The most common cause of pain at this site is a condition traditionally known as plantar fasciitis, which we now refer to as plantar fasciopathy. The shift from the suffix -itis to -pathy indicates that this condition notably lacks inflammatory cells and is better categorized as a degenerative change.
Other symptoms that help us define this as plantar fasciopathy is pain that builds over long periods of standing, reduced ankle motion and a feeling of tightness in the achilles tendon, pain that worsens when walking barefoot, and a preference for toe walking.
The plantar fascia is a fibrous connective tissue that supports each foot’s longitudinal arch (see below) and plays a role in shock absorption.
When injured, ultrasound findings tend to display microtears, calcification and thickening of the fascia, and a bone spur may also be present at the point of attachment.
This is particularly evident close to the plantar fascia’s origin at the inner surface of the heel bone (calcaneus). This is where most people experience their pain.
Altogether these findings are indicative of repetitive strain and excessive mechanical loading.
The following factors may contribute to excessive mechanical loading:
Restrictions in ankle motion, often due to tight calf muscles. We use a weight bearing lunge test to evaluate this and anything less than 10cm should be addressed
Weakness of the intrinsic foot muscles. This can be assessed as your capacity to ‘dome’ the arch of your foot or pick up different objects with your foot (towel, marbles etc.)
Excessive foot pronation. Please note that pronation is a feature of healthy foot mechanics but needs to function within a certain range.
Weakness of the calf muscles which perform plantar flexion. This is the movement performed at the ankle whilst rising on to one’s toes. The calf musculature is the greatest contributor to forward propulsion whilst running.
Elevated BMI. This can pose a significant barrier if your goal is to reduce your body weight through aerobic exercise.
Leg length discrepancy. This can be evaluated by an Osteopath but is more accurately measured through EOS scanning.
Improper shoe fit
So, what can you do if this pain has developed and is not going away with rest?
As mentioned above, the lack of inflammation makes this unlikely to respond to anti-inflammatory therapy.
There’s a need to change the environment around the plantar fascia to reduce repetitive strain.
Quite often patients will present with heel pain after an increase in physical activity or a change of footwear.
Provided all other predisposing factors are under control then what we look to do is select the most appropriate footwear for your foot type.
We then build a training program that incrementally changes, whilst maintaining enough challenge to prompt tissue adaptation.
Here are some general recommendations:
If you are looking for a low-budget approach, then you could begin with an off the shelf orthotic designed for plantar fasciopathy. These have a soft pad that will be positioned beneath the tender point on your heel.
Ensure your weight bearing lunge test is 10cm or greater on both sides. To perform this test place your big toe 10cm away from a vertical surface, then see if you can drop your knee forward to reach this surface without your heel leaving the ground.
Wear supportive shoes and wear them in situations you may otherwise opt for bare feet. If you are unclear on the correct shoe fit, then seek advice.
Replace load bearing exercises such as running with cycling or swimming.
Visit a health professional such as an Osteopath to ensure this is in fact the condition you are suffering from and to evaluate global biomechanics, such as the movement available at your knee and hips.