Plantar Fasciopathy

May 05, 2023 4:25pm

What is it?

Pain in the sole of the foot can be caused by various issues, within and outside of the foot. Most commonly, pain on the sole of the foot is caused by plantar fasciopathy. That’s an ominous sounding condition, so let’s break down what those words actually mean.

  • Plantar comes from the latin planta which means sole of the foot.
  • Fasciopathy is made up of two words - fascia - which is latin for ‘band’ and pathy which comes from the latin for ‘suffering’.

 So, plantar fasciopathy is the suffering of the bands on the sole of the foot!

Interestingly, plantar fasciopathy was previously (and is still commonly) known as plantar fasciitis. However, the suffix itis refers to inflammation and this is not always present in this condition, so fasciopathy is a more accurate diagnosis.

In the picture, you can see the plantar fascia - the thick connective tissue that supports the arch of the foot and helps absorb the impact from the ground.

What causes plantar fasciopathy?

Now that we know what the plantar fascia does, let’s examine why it can be so painful. The human body is an incredibly robust and adaptable organism, but it has limits. When we ask too much of the body, our protective mechanisms kick into gear to ensure we don’t cause harm. The most apparent of these is pain. When we load the structures on the sole of the foot beyond well beyond what they are capable of tolerating, pain can ensue.

Plantar fasciopathy symptoms usually include:

  • Pain on the bottom, inside part of the heel, and sometimes in the arch of the foot.
  • The pain is often worst when getting up in the morning, but typically eases after walking for a while.
  • The symptoms tend to get worse over the course of the day or with impact activities like jumping.

There are various causes of overload but the main risk factors are:

  • A sudden increase in the amount of physical activity, especially weight bearing activities like walking, jogging and jumping → This loads the plantar fascia beyond what it can handle.
  • Carrying too much adipose (fat) tissue → Carrying extra body weight puts more load through the feet, but excess adipose tissue also releases adipokines which are pro-inflammatory, increasing the risk of musculoskeletal conditions.

As physiotherapists, a common presentation of plantar fasciopathy is a recently retired office worker who has been training for a 10 km charity walk in order to lose weight. In this case, the person has all the risk factors for plantar fasciopathy, but it’s not always this obvious. Many times, the person may have no clear risk factors at all!


Why is it significant?

Plantar fasciopathy is a very common condition. The prevalence in people over 50 has been estimated at around 10% and the majority of those cases result in disabling heel pain - or pain that limits daily activities like walking.

At Be Mobile Physiotherapy, plantar fasciopathy is one of the topics we are asked about most frequently. When you have plantar fasciopathy, almost any activity on your feet can become troublesome. This presents a big opportunity! If we can help you reduce your heel or foot symptoms, activities like walking the dog, running around with grand kids or dancing will become open to you!


Now that we have an idea of what plantar fasciopathy is and what causes it, let’s discuss how best to treat it!

As we observed earlier, a sudden increase in load or loading beyond your capacity can increase the symptoms of plantar fasciopathy. So, a good first step is to instigate load management. This will be dependent on the person but may include strategies such as:

  • Reducing the time spent standing at work
  • Temporarily reducing the amount of walking
  • Taking regular seated rests during house work

If you are carrying excess body weight, losing some weight can also help!

There are many passive strategies used to manage the symptoms of plantar heel pain. These include:

  • Orthotics
  • Shockwave therapy
  • Corticosteroid injections

The evidence on these treatments are conflicting, with some studies showing they work well, whilst others showing negligible or only short term pain relief. What none of them do is increase the capacity of the tissues. The only way to do that is with exercise.

So, once the symptoms have settled to tolerable levels, resistance training can be incorporated to gradually increase the capacity and load tolerance of the plantar fascia.

Check out this video to see  Jack and Ollie demonstrate the best exercises for plantar fasciopathy.