Plantar heel pain is a common condition that affects people of all ages and activity levels. While traditionally referred to as “plantar fasciitis,” recent research has shown that the true issue is plantar fasciopathy, a degenerative condition rather than an inflammatory one. The plantar fascia is a thick band of connective tissue that plays a crucial role in foot mechanics. When this tissue undergoes degenerative changes due to chronic overload or stress, pain and dysfunction occur.
Why is it not Fasciitis?
The suffix “-itis” implies inflammation; however, scientific studies have demonstrated that most cases of chronic plantar heel pain do not exhibit signs of inflammation. Instead, researchers have found degenerative changes, collagen breakdown, and disorganized healing in affected tissue.
A study by Lemont et al. (2003) examined histological samples of plantar fascia from patients with chronic heel pain and found no evidence of inflammatory cells, but rather signs of myxoid degeneration, collagen disarray, and fibroblast proliferation [1]. Similar findings were reported by Dragoni et al. (2021), who noted that plantar fasciopathy is best understood as a failed healing response rather than an inflammatory process [2].
This distinction is important because it affects treatment approaches—traditional anti-inflammatory treatments such as corticosteroid injections or NSAIDs may not address the root cause of the condition.
Anatomy of the Plantar Fascia and Heel Structures:
Plantar Fascia: A dense, fibrous tissue that supports the arch and absorbs shock during walking and running.
The Heel Pad: A fatty cushion that provides additional shock absorption.
The Calcaneus: A major structural component providing a base for the plantar fascia.
The Achilles Tendon: A crucial tendon connecting the calf muscles to the heel bone, influencing foot biomechanics.
Nerves and Muscles: Several nerves, including the tibial nerve and lateral plantar nerve, as well as intrinsic foot muscles, contribute to heel function and stability.
Symptoms of Plantar Heel Pain:
The primary symptom of plantar heel pain is pain in the heel area as the name describes, particularly when walking or standing. The symptoms of plantar heel pain can vary depending on the underlying causes, but the most common symptoms include:
Gradual onset of heel pain, often felt on the underside of the heel.
Morning pain or pain after periods of rest, which improves with movement but worsens after prolonged activity.
Tenderness at the medial aspect of the heel where the plantar fascia originates.
No visible swelling or redness, distinguishing it from inflammatory conditions
Causes of Plantar Heel Pain:
Plantar fasciopathy is typically the result of repetitive microtrauma and chronic stress on the plantar fascia. Factors contributing to its development include:
Overuse and mechanical overload (e.g., running, prolonged standing, walking on hard surfaces)
Poor foot biomechanics, including flat feet or high arches
Reduced tissue healing capacity, particularly in individuals with metabolic conditions like diabetes
Tightness or weakness in the calf and foot muscles
Inappropriate footwear lacking support or cushioning
Treatment of Plantar Heel Pain:
Since plantar fasciopathy is not primarily an inflammatory condition, effective treatments focus on tissue remodeling and load management rather than inflammation reduction. Soft Tissue Occupational Therapy: A Soft Tissue Occupational Therapist provides biomechanical assessment and manual therapy techniques to improve fascial function. Treatment may include:
Progressive loading exercises to stimulate proper tissue remodeling and collagen realignment.
Myofascial release and mobilization to reduce mechanical strain on the plantar fascia.
Foot and calf strengthening to address muscle imbalances that contribute to excessive strain.
Shockwave therapy, which has been shown to stimulate tissue regeneration and improve symptoms.
Orthotic therapy to provide biomechanical support and offload stress on the plantar fascia.
Taping and night splints to help maintain optimal foot position and reduce stress during rest
It is super important to consult with your healthcare professional for an accurate diagnosis and an appropriate diagnosis and treatment plan for your plantar heel pain. No ones issues are the same, and can be a combination of many underlying causes and conditions, so seeking that professional help can really help to fix the issue and get you on to the road to recovery!
References:
Lemont H, Ammirati KM, Usen N. “Plantar fasciitis: a degenerative process (fasciosis) without inflammation.” J Am Podiatr Med Assoc. 2003;93(3):234-7.
Dragoni S, Soleymani T, McAlindon T, et al. “Histological and Imaging Evidence for Plantar Fasciopathy as a Degenerative Condition.” Foot Ankle Int. 2021;42(4):495-502.
Rathleff MS, Mølgaard CM, Fredberg U, et al. “High-load strength training improves outcomes in patients with plantar fasciopathy: A randomized controlled trial.” Scand J Med Sci Sports. 2015;25(3):e292-e300.
Gerdesmeyer L, Frey C, Vester JC, et al. “Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis: Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study.” Am J Sports Med. 2008;36(11):2100-2109.
