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Heel Pain/Plantar Fasciopathy - previously known as plantar fasciitis

Plantar fasciopathy is considered one of the most common foot abnormalities, affecting up to 2 million Americans each year, with the chief complaint being acute heel pain. Previously known as plantar fasciitis, now referred to as plantar fasciopathy. The reason being, fasciitis implies inflammation, studies show no signs of inflammation but rather disorganized fibrous tissue.

What is plantar fascia?

Plantar fascia is the fibrous tissue found on the bottom of the foot, supporting the arch. Symptoms include severe pain in a.m. with initial steps, decreasing with continued walking. Pain returns with prolonged walking and weight bearing.

Who gets plantar fasciopathy?

Plantar fasciopathy can occur in athletic and sedentary populations, typically between 40-60 years old (present in younger populations as well), women slightly more than men.

Associate Risk Factors

obesity, high or low arches, limited ankle range of motion, weak muscles, tight hamstrings and calves, hard surfaces, poor footwear. When plantar fasciopathy is present in both feet, it is associated with rheumatoid arthritis, systemic lupus erythematosus, and gout.

What is the cause?

Plantar fasciopathy is caused from a mechanical dysfunction. This simply means how the foot is used during daily life such was walking, standing, or running. The foot and ankle must be flexible to absorb shock, adaptable to varying terrains, and become a rigid lever to propel the body during movements like walking and running. When the lower extremity (hip, knee, ankle, & foot) are not functioning properly, the plantar fascia can become irritated and over stressed, resulting in plantar fasciopathy.

Differential diagnosis (other causes of heel pain)

Posterior tibial nerve entrapment, diabetes, lumbar dysfunction, S1 entrapment, Baxter's nerve entrapment, medial calcaneal nerve entrapment, fracture, sever's disease, fat pad atrophy, contusion, tendinopathy, bursitis, benign and malignant conditions.

Evidence Supported Interventions

- Manual therapy: improved pain scores and self reported function.

- Night split in combination with foot orthosis: The combination of the two interventions was superior to the application in foot orthoses alone in relieving foot pain

- Custom foot orthoses more effective than sham orthoses in improving function, but not for reducing pain after 3 and 12 months

- Trigger point dry needling vs sham dry needling: Limited evidence for dry needling into muscle trigger points

- Modalities (including ultrasound, TENS, Iontophoresis): no significant improvement and failed to support the use over manual therapy.

- Corticosteroid Injections: benefits do not off set the risks. Potential risk include injection-site pain, infection, subcutaneous fat atrophy, plantar fascia rupture, peripheral nerve injury, and muscle damage.

Treating Plantar Fasciopathy

According to the latest evidence (in the last 5 years) manual therapy is the superior treatment of choice. However, manual therapy alone will not address the root cause of the problem and is not the end all be all.

Remember, the root cause of plantar fasciopathy is a mechanical dysfunction resulting in increased stress on the plantar fascia. Physical Therapist are movement specialist who will address your body mechanics, returning optimal function, so the plantar fascia is not being over worked and stressed.

Feel free to contact us at 512-298-3903 with any questions that you may have.

Special thanks to contributing authors Vince Lauderdale, PT, DPT & Jansen Yamout, PT, DPT


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