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'Plantar fasciitis' or 'plantar fasciopathy'? | Find Your Stride

Updated: Mar 16, 2023

Plantar fasciitis has to be the most frequently talked about complaint in podiatry. A day in clinic rarely passes without this annoying injury popping up, because it's just SO common! I can't write about plantar fasciitis without first addressing the debate surrounding it's name, because I much prefer calling it plantar fasciopathy (and for good reason!). Interested? Read on below.


What's it called?

The on-going debate regarding the name of plantar fasciitis emphasises the uncertainty surrounding it’s aetiology. For example Bartold (2004) and Riel et al. (2017) champion ‘plantar heel pain syndrome’ and ‘plantar heel pain’ respectively because these umbrella terms can be used until a more accurate diagnosis is obtained. These terms also draw attention to a number of differential diagnoses that could occur concurrently and must always be excluded, such as bone injury, calcaneal stress reaction, rupture, sub-calcaneal bursitis or nerve entrapment, all of which are often difficult to diagnose without imaging.


Plantar fasciitis is probably the term used most frequently, however it implies that inflammation is present. It has been suggested that degeneration and consequent thickening of the plantar fascia is more common and often present without inflammation, hence plantar fasciopathy or plantar fasciosis are presented as more appropriate names (Fabrikant, & Park, 2011). Confusingly all of the aforementioned terms are often used inter-changeably by foot and ankle practitioners, when describing any presentation matching the clinical markers consistent with plantar fasciopathy. However, to keep things simple from here on out I'm going to stick with plantar fasciopathy for the duration of this post because it's a more accurate discription of the most commonly encountered complaint!


Anatomy, Prevalence and Clinical Markers

So, plantar fasciopathy involves the plantar aponeurosis, a strong fibrous band that maintains the longitudinal arch of the foot (Abrahams, Marks, McMinn, & Hutchings, 2003), it sits superficial to the plantar musculature originating from the anterior calcaneal tubercle before extending distally and separating into five slips that insert at the proximal phalanx of each toe, joining with the deep transverse metatarsal ligaments. Plantar fasciopathy is diagnosed when the plantar aponeurosis becomes thickened, which can occur with or without inflammation (Monteagudo, Martinez de lbornoz, Gutierrez, Tabuenca, & Alvarez, 2018; Riel et al., 2017). It has been suggested that acute cases (approximately four months duration) demonstrate inflammatory processes while chronic cases (one to two years duration) do not (Ribeiro, Joao, Dinato, Tessutti, & Sacco, 2015).


The main clinical marker of plantar fasciopathy is acute pain at the plantar-medial calcaneus felt when weight-bearing immediately after a period of rest. This sharp, sudden sensation usually passes after a few minutes of walking but then returns with less intensity later in the day (League, 2008). Kadakia, Fischer, & Haddad (2010) specify other clinical markers such as maximum tenderness with palpation over the plantar-medial calcaneus, worsening pain with ankle and 1st metatarsophalangeal joint dorsiflexion, improved pain with plantarflexion of the same joints and greater pain following exercise that is not present during the activity.


Prevalence and Risk Factors

100% of respondents to the Physical Therapist Foot Care Survey conducted by Reischl (2001) identified plantar fasciopathy as the condition seen most frequently during their clinics. Risk factors are numerous; they include obesity, diabetes, footwear choices, inflammatory arthritis and standing for long hours each day (League, 2008; McPoil et al., 2008). plantar fasciopathy is also common amongst running athletes; it is thought that approximately 10% will experience related symptoms (Bartold, 2004), while Lopes, Junior, Yeung, & Costa (2012) have published results to suggest that plantar fasciopathy is the third most prevalent musculoskeletal injury amongst this group.


Summary

This whistle stop tour summarises some of the research surrounding plantar fasciopathy and gives an insight into how we diagnose the complaint. The heel is complex so if your practitioner is quick to diagnose plantar fasciopathy or plantar fasciitis without having a proper look, be sure to question them.


Find Your Stride!


References

Bartold, S. J. (2004). The plantar fascia as a source of pain—biomechanics, presentation and treatment. Journal of bodywork and movement therapies, 8(3), 214-226. doi:10.1016/S1360-8592(03)00087-1


Lopes, A. D., Hespanhol Jr, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the Main Running-Related Musculoskeletal Injuries?: A Systematic Review. Sports medicine (Auckland), 42(10), 891-905. doi:10.1007/BF03262301


League, A. C. (2008). Current Concepts Review: Plantar Fasciitis. Foot & ankle international, 29(3), 358-366. doi:10.3113/FAI.2008.0358


McPoil, T. G., Martin, R. L., Cornwall, M. W., Wukich, D. K., Irrgang, J. J., & Godges, J. J. (2008). Heel pain - Plantar fasciitis: Clinical practice guidelines linked to the international classification of function, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. The journal of orthopaedic and sports physical therapy, 38(4), A1-A18. doi:10.2519/jospt.2008.0302


Kadakia, A.R, Fischer, S.J., & Haddad, S.L. (2010). Plantar Fasciitis and Bone Spurs. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs/


Ribeiro, A. P., João, S. M. A., Dinato, R. C., Tessutti, V. D., & Sacco, I. C. N. (2015). Dynamic patterns of forces and loading rate in runners with unilateral plantar fasciitis: A cross-sectional study. PloS one, 10(9), e0136971-e0136971. doi:10.1371/journal.pone.0136971


Monteagudo, M., de Albornoz, P. M., Gutierrez, B., Tabuenca, J., & Álvarez, I. (2018). Plantar fasciopathy: A current concepts review. EFORT Open Reviews, 3(8), 485-493. doi:10.1302/2058-5241.3.170080


Abrahams, P., McMinn, R. M. H., Marks, S. C., & Hutchings, R. T. (2003). McMinn's color atlas of human anatomy (5th ed.). Edinburgh: Mosby.


Fabrikant, J. M., & Park, T. S. (2011). Plantar fasciitis (fasciosis) treatment outcome study: Plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement. Foot (Edinburgh, Scotland), 21(2), 79-83. doi:10.1016/j.foot.2011.01.015


Riel, H., Cotchett, M., Delahunt, E., Rathleff, M. S., Vicenzino, B., Weir, A., & Landorf, K. B. (2017). Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. British journal of sports medicine, 51(22), 1576-1577. doi:10.1136/bjsports-2017-097519

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