The injury that is literally a pain in the sole. Most commonly known as plantar fasciitis this condition truly makes function very difficult. A painful condition that is prone to become chronic and seriously reduce an individuals quality of life. Other more modern names for this condition include plantar heel pain and plantar fasciopathy. Why are these terms actually preferred to describe the condition in the modern day? Well the pathology of the tissue is less inflammatory in nature (like ‘fasciitis’ suggests) and is actually more a thickening and degenerative response.

It is important to note that not all pain on the sole of the foot is due to plantar fasciopathy. It is crucial that the cause is determined so the appropriate management can be implemented.

What else could cause plantar heel pain?

• Fat pad atrophy - Normally occurs in older adults and worsens with ambulation.

• Fat pad contusion - Acute onset mechanism of injury.

• Baxter’s neuropathy - Will have a palpable pain over the inside aspect of the heel and up to 20% of heel pain cases are estimated to be due to this condition. This however, is commonly misdiagnosed as symptoms resemble plantar fasciopathy.

• Calcaneal stress fracture - Will have resting pain.

• Plantar fascia rupture - Acute onset mechanism of injury and pain located more distal to the heel. It also does not improve with ambulation.

One characteristic that true plantar fasciopathy will have is that the pain and symptoms improve with activity. This is similar to our tendon reaction injuries in that the issue warms up and then feels worse after activity or periods of prolonged rest. One symptom that is very frequent and typical of plantar fasciopathy is having “first step pain” in the morning or after periods of inactivity. It can take a few steps for the pain to reduce and often goes away.

Who gets plantar fasciopathy (plantar fasciitis)?

Like most conditions it does not discriminate. However it typically occurs in two different groups. The sedentary individual and the running athlete.

Risk factors in the sedentary population:

• High BMI

• Flat foot in standing (pes planus)

• A thickened plantar fascia

• Heel pad thickening

• Heel spur

• Baxter’s neuropathy

Risk factors among the running population:

• Genus varum (bow legs when running)

• Running shoes with spikes

• High arched foot (pes cavus) - Due to reduced ability to shock absorb

• More days running per week

• More years as an active runner

• More kilometres running per week

What leads to a worse prognosis?

• Symptom duration longer than 7 months

• Female sex

• Age < 40 years

• Bilateral plantar fasciopathy (occurring in both feet)

Very important to note is that BMI, the plantar fascia thickness and the presence of a heel spur do not play a role in prognosis.

The presence of a heel spur is also only present in two thirds of individuals with plantar heel pain. Additionally, only half of heel spurs are actually painful.

If you want an appropriate modern management plan for your plantar heel pain, then booking in at The Reform Lab Osteopathy is your step to pain free steps. We are one of the only allied health clinics fortunate enough to not be limited by rehabilitation equipment. Our clinic is located inside the elite Project Reform performance gym.

Ensure you read our informative blog on plantar fasciopathy with supporting modern research - ‘Plantar Fasciitis - A pain in the sole’