Plantar Fasci-What-The?!

At some point in our lives, we all experience heel pain. This might occur after wearing those lovely-looking (but painful!) high-heels, standing at a function for an extended period, or trying that new high-intensity exercise class.

But what happens when the pain doesn't go away on its own? How do you know when the pain has progressed from just an annoying niggle to something that needs treatment?

If you ticked one or more of these boxes above, the pain you are experiencing could be a problem in your plantar fascia and should be assessed by a podiatrist.

What is the Plantar Fascia?

The plantar fascia is a thick fibrous band of connective tissue that runs from the bottom of your heel bone (calcaneus) to your toes. 

The plantar fascia performs a vital role when you stand or walk. During gait, the plantar fascia absorbs shock as your foot strikes the ground. It then stabilises the arch of your foot as you move your body weight onto your toes to step forward.

Although your plantar fascia is strong, it does bear the whole weight of your body! So, it is common for the plantar fascia to become overworked, overstrained, and, at times, a little tender.

Plantar Fasciitis vs Plantar Fasciopathy

Plantar heel pain is most commonly caused by a condition that is commonly referred to as "plantar fasciitis."

However, the term "plantar fasciopathy" more accurately describes the changes seen within the plantar fascia in this disorder (so that’s why I’ll use the term plantar fasciopathy rather than plantar fasciitis throughout this article).

Heel pain may also be due to other causes, such as a stress fracture, tendinopathy, arthritis, nerve irritation, or, rarely, a cyst.

 Plantar Fasciopathy

Plantar fasciopathy can be caused by acute trauma (such as a fall or jumping from a height), resulting in a plantar fascia tear.  Or it can be the result of repetitive strain and micro-tearing.

With chronic and repetitive stress over time, the plantar fascia can degenerate, leaving it weaker and more prone to episodes of irritation.

This deterioration is known as "plantar fasciosis" and, without appropriate treatment, can lead to months - or even years - of chronic heel pain.

Symptoms

Plantar fasciopathy generally develops slowly over time, so it often is only addressed once symptoms have been present for quite a while.

Plantar fasciopathy typically causes pain at the bottom of the heel or sometimes at the bottom of the mid-foot area. It usually affects just one foot, but in some cases, it can affect both feet.

The pain can be dull or sharp. Some people feel a burning or ache on the bottom of the foot, travelling towards the toes.

The pain is usually at its worst first thing in the morning after getting out of bed and taking the first few steps of the day.

Symptoms can also be triggered by long periods of standing or when you stand up after resting.  Pain is usually worse after exercise, not during it.

Causes & Risk Factors

Age & sex: heel pain is most commonly seen between the ages of 40 and 60 and is more prevalent in women.

Certain types of exercise: activities that place a lot of stress through your plantar fascia (such as long-distance running, ballet dancing, or aerobic fitness) can lead to plantar fasciopathy. 

Sudden changes: heel pain may occur with a sudden increase in physical activity - like starting a new fitness class, joining a gym, or starting a new job - without easing into the new routine.  It also commonly occurs when everyday footwear is changed.

Footwear: shoes that increase stress through the plantar fascia (such as high heels or thongs) can also result in heel pain.

It can also occur after wearing shoes that lack adequate support -  particularly arch support - which helps to reduce the load through the plantar fascia.

In some cases, your shoes might be supportive, but they have simply worn out and need replacing. We always encourage patients to bring as many pairs of shoes to their initial appointments as possible so we can assess these and make recommendations.

Foot mechanics: flat feet, a high arch, or even an abnormal walking pattern can affect stress through the plantar fascia.

Body weight: additional body weight will also put extra stress through the plantar fascia.

Occupations that keep you on your feet: nurses, retail workers, teachers, tradespeople, and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

When should I see a Podiatrist?

The good news is that heel pain responds very well to non-invasive therapy!  Around 90% of people with plantar fasciopathy report improved symptoms within two months of initial treatment.

However, it is vital first to obtain a correct diagnosis of the underlying cause - as not all heel pain is caused by plantar fasciopathy.

Your podiatrist will be able to assess your heel pain expertly and, in some cases, will refer you for scans to confirm the diagnosis.

Once a diagnosis is established, treatment is focused on pain relief, stretching & strengthening, promoting healing, and addressing the underlying cause(s) in your case.

As plantar fasciopathy is a chronic condition, your podiatrist will also give you strategies to reduce episodes of heel pain in the future.

This article was originally published on the Blackwood Podiatry Blog in June 2021. It has been updated by Nicole Morgan in November 2023.