Plantar Fasciopathy

What Is Plantar Fasciopathy?

Plantar fasciopathy (often also called plantar fasciitis) is one of the most common causes of pain in the lower heel area. This is not a classic inflammation, but rather an overload and degenerative condition of the plantar fascia, a strong band of connective tissue on the sole of the foot (1) (2).

The plantar fascia runs from the heel bone (calcaneal tuberosity) to the metatarsophalangeal joints and plays a central role in the stability of the longitudinal foot arch as well as in shock absorption during walking and running (3) (4). If it is repeatedly loaded over a longer period without sufficient recovery, microinjuries, structural changes in the collagen, and reduced tissue resilience can occur (5).

Typical symptoms are sharp, localized pain in the middle to lower heel area, particularly with the first steps in the morning or after longer periods of rest. The symptoms often improve after a few minutes, but tend to return or worsen over the course of the day (6) (7).

Who Is Affected?

Plantar fasciopathy is a common cause of heel pain. About one in ten people are affected by it at some point in their lives (2). It can occur at any age, but most commonly between 45 and 65 years.

Particularly affected are:

• Runners
• People who stand or walk a lot for work
• Physically active people (in runners, symptoms often appear earlier) (2)

Why Does Plantar Fasciopathy Develop?

Plantar fasciopathy usually does not result from a single cause, but from the interplay of several contributing factors (8). The key factor is that the plantar fascia is loaded more heavily over time than it can recover from.

Common risk factors include:

• Overload, e.g. prolonged standing or walking on hard surfaces (9)
• Too rapid an increase in training volume, frequency or intensity
• Limited ankle mobility
• Overweight or rapid weight gain
• Faulty foot loading, e.g. excessive inward rolling (overpronation)
• Fatigue and insufficient recovery (10)

Diagnosis

There is no single test that definitively proves plantar fasciopathy (11). Diagnosis is made primarily through a thorough discussion and physical examination (12). The diagnosis is made by a physician.

Typical signs include:

• Pressure pain at the lower heel
• Pain with the first steps in the morning or after rest periods
• Pain when stretching the plantar fascia
• Limited ankle mobility
• Noticeable foot posture

Questionnaires are used to assess the course of the condition, allowing patients to evaluate their own symptoms and function (13).

For unclear or persistent symptoms, an ultrasound examination can also be performed. A thickened plantar fascia (over 4 mm) suggests plantar fasciopathy (14). MRI or X-ray are mainly used to rule out other causes (15).

What Do We Do in Physiotherapy?

Physiotherapy treatment is tailored individually to your symptoms, daily life and goals. It is based on a thorough medical history discussion and a functional examination.

Possible treatment components include:

• Load management and education to prevent chronicity (13)
• Manual therapy, particularly to improve ankle mobility
• Soft tissue techniques for pain reduction
• Focused shockwave therapy
• Targeted stretching exercises for the calf muscles and plantar fascia
• Strengthening of the foot, leg and hip muscles for better load control (16)
• Taping for short term pain relief (up to approx. 3 weeks)
• Night splints for severe morning start up pain

Studies show that many patients can achieve significant improvement or complete pain relief with a structured stretching and exercise program (17) (18).

Dry needling can be used as a complementary treatment for tense muscle areas. In most cases, symptoms improve significantly within 6 to 12 months. Early and individually tailored physiotherapy can positively influence the healing process and make it easier to return to daily life and sport (19).

Text: Tatiana Ryll_‍

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_{(1)  Porta, G. A. L., & Fata, P. C. L. (2005). Pathologic conditions of the plantar fascia. Clinics in Podiatric Medicine and Surgery, 22(1), 1–9. https://doi.org/10.1016/j.cpm.2004.08.001‍}

_{(2) Young, C., Cotton, D., Taichman, D., & Williams, S. (2012). Plantar Fasciitis. Annals of Internal Medicine, 156(1_Part_1), ITC1-1. https://doi.org/10.7326/0003-4819-156-1-201201030-01001‍}

_{(3) Hicks, J. H. (1954). The mechanics of the foot. Journal of Anatomy, 88(Pt 1), 25-30.1.}

_{(4) Stukenborg-Colsman, C., Fuhrmann, R. A., Abbara-Czardybon, M., Arnold, H., Becher, C., Bernateck, M., Bock, P., Claaßen, L., Daniilidis, K., Döderlein, L., Dohle, J., Evers, J., Frank, D., Gabel, M., Grass, R., Greitemann, B., Lieske, S., Lohrer, H., Manegold, S., … Westhoff, B. (2017). Kurzgefasste Fußchirurgie (2017. Aufl.). Thieme Verlag. https://doi.org/10.1055/b-004-132244}

_{(5) Buchanan, B. K., Sina, R. E., & Kushner, D. (2024). Plantar Fasciitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK431073/}

_{(6) Beeson, P. (2014). Plantar fasciopathy: Revisiting the risk factors. Foot and Ankle Surgery, 20(3), 160–165. https://doi.org/10.1016/j.fas.2014.03.003‍}

_{(7) Monteagudo, M., de Albornoz, P. M., Gutierrez, B., Tabuenca, J., & Álvarez, I. (2018). Plantar fasciopathy. EFORT Open Reviews, 3(8), 485–493. https://doi.org/10.1302/2058-5241.3.170080‍}

_{(8) van Leeuwen, K. D. B., Rogers, J., Winzenberg, T., & van Middelkoop, M. (2016). Higher body mass index is associated with plantar fasciopathy/’plantar fasciitis’: Systematic review and meta-analysis of various clinical and imaging risk factors. British Journal of Sports Medicine, 50(16), 972–981. https://doi.org/10.1136/bjsports-2015-094695‍}

_{(9) Petraglia, F., Ramazzina, I., & Costantino, C. (2017). Plantar fasciitis in athletes: Diagnostic and treatment strategies. A systematic review. Muscles, Ligaments and Tendons Journal, 7(1), 107–118. https://doi.org/10.11138/mltj/2017.7.1.107}

_{(10) Patel, A., & DiGiovanni, B. (2011). Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot & Ankle International, 32(1), 5–8. https://doi.org/10.3113/FAI.2011.0005}

_{(11) McNally, E. G., & Shetty, S. (2010). Plantar fascia: Imaging diagnosis and guided treatment. Seminars in Musculoskeletal Radiology, 14(3), 334–343. https://doi.org/10.1055/s-0030-1254522}

_{(12) Alazzawi, S., Sukeik, M., King, D., & Vemulapalli, K. (2017). Foot and ankle history and clinical examination: A guide to everyday practice. World Journal of Orthopedics, 8(1), 21–29. https://doi.org/10.5312/wjo.v8.i1.21}

_{(13) Koc JR, T. A., Bise, C. G., Neville, C., Carreira, D., Martin, R. L., & McDonough, C. M. (2023). Heel Pain – Plantar Fasciitis: Revision 2023. Journal of Orthopaedic & Sports Physical Therapy. https://doi.org/10.2519/jospt.2023.0303}

_{(14) 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. https://doi.org/10.1016/j.foot.2011.01.015}

_{(15) Trojian, T., & Tucker, A. K. (2019). Plantar Fasciitis. American Family Physician, 99(12), 744–750.}

_{(16) Bolgla, L. A., & Malone, T. R. (2004). Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice. Journal of Athletic Training, 39(1), 77–82.}

_{(17) Digiovanni, B. F., Nawoczenski, D. A., Malay, D. P., Graci, P. A., Williams, T. T., Wilding, G. E., & Baumhauer, J. F. (2006). Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. The Journal of Bone and Joint Surgery. American Volume, 88(8), 1775–1781. https://doi.org/10.2106/JBJS.E.01281}

_{(18) Engkananuwat, P., Kanlayanaphotporn, R., & Purepong, N. (2018). Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis. Foot & Ankle International, 39(1), 75–82. https://doi.org/10.1177/1071100717732762}

_{(19) Colakovic, H. (2019). Wenn die Sohle schmerzt – Evidenz-Update Plantarfasziitis. physiopraxis, 17(05), 20–25. https://doi.org/10.1055/a-0867-6624}

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