What is plantar fasciitis?
Plantar fasciitis, now referred to as plantar fasciopathy, refers to the degeneration of the plantar fascia, a tissue on the sole of the foot. The typical symptom is pain on the inner edge of the heel, especially in the mornings.
What helps with plantar fasciitis?
Can plantar fasciitis be cured?
Various conditions in the foot, ankle, and sole are very common in the population. One of the most common musculoskeletal disorders in the sole of the foot is called plantar fasciitis (PF). For example, in America, PF accounts for over a million annual doctor visits, while among athletes, especially runners, the prevalence is over 17%. Although the term plantar fasciitis is still commonly used, it is likely a degenerative condition of the plantar fascia rather than inflammatory changes, hence the term plantar fasciopathy is now recommended. Sometimes in the literature, you may also come across terms like tendinopathy, fasciosis, tendinosis, or tendinitis. There is limited good research available on the prevalence of plantar fasciopathy in Finland. The condition is particularly common among 40-60-year-olds and runners, and it can also affect both feet simultaneously. (1)
Symptoms
The main symptom of plantar fasciopathy is pain on the inside of the heel. Typically, the pain is most pronounced in the morning upon waking up, especially with the first few steps. The pain gradually eases with movement, but symptoms often worsen again towards the evening. Sports activities and impact on the heel typically provoke pain as well. About one-third of individuals experience symptoms in both heels/soles. The inner edge of the heel is usually tender to touch. Approximately 95 percent of cases of plantar fasciopathy improve conservatively (without surgical treatment) within a year, so the condition can last quite a long time.
The exact cause of plantar fasciopathy is currently unknown, but it is suspected that particularly ankle dorsiflexion deficiency is associated with the condition's persistence. Other musculoskeletal disorders that can cause similar symptoms in the heel area include Haglund's syndrome, calcaneal stress fracture, and tarsal tunnel syndrome. However, the aforementioned conditions are rarer than plantar fasciopathy. (1,2)
Risk factors
Although the risk factors for plantar fasciopathy have been studied, the research quality is not very high. Below is a list of the most common factors associated with plantar fasciopathy:
Gender: Plantar fasciopathy occurs almost equally in both men and women. (1,2)
BMI: Overweight appears to increase the risk of plantar fasciopathy becoming chronic. (1,2)
Physical work: Jobs involving prolonged standing or walking may be a risk factor for the development of plantar fasciopathy. (1,2)
Heel spurs: The connection between heel spurs and heel pain is uncertain in the field of science. Currently, it appears that neither the shape nor the size of the heel spur affects pain or functionality. However, individuals with plantar fasciitis are more likely to have heel spurs. (1,2)
Biomechanics: Some researchers believe that tightness in the calf muscle (gastrocnemius) may be a cause of plantar fasciopathy in some cases. (1,2)
Management
As mentioned earlier in the text, the vast majority of cases of plantar fasciopathy heal without surgical treatment within a year. There are many different treatment options available. However, the problem in this case, unfortunately, is that currently we do not know, based on scientific evidence, which treatment modalities are the best or even effective. Therefore, treatment is usually based on the professional's own experiences and the individual needs of the patient. Below is a list of typical treatment options that may help alleviate symptoms:
Strength training
Stretching
Orthotics/insoles, night splints
Injection therapies such as cortisone or platelet-rich plasma (PRP) treatment
Extracorporeal shockwave therapy (ESWT)
Manual therapy, such as massage & acupuncture
Surgical treatment if symptoms do not improve with conservative measures
Although research on plantar fasciopathy does not yet provide clear answers regarding the effectiveness of treatments, many patients still find relief from symptoms through therapeutic exercise and counseling. If you suffer from pain in the plantar region and cannot manage the situation at home, it is advisable to seek professional help.
Ilari Keckman
Osteopath, sports massage therapist & educator
Joonas Virtanen
Osteopath, sports massage therapist, physical trainer & physiotherapy student
References
留言