17 May Plantar fasciopathy – a pain in the foot.
Plantar fasciopathy is a problem with the plantar fascia. The plantar fascia is a band of strong, thick connective tissue that spans the base of the foot from the calcaneus, your heel bone, to the toes. It plays a large role in increasing the strength of the arches of the foot, tying the bones of the foot together to prevent them collapsing under your weight.
The pain from plantar fasciopathy will be around the base of the heel, from under the heel to the front of the heel, if it is on the back of the calcaneum then it is much more likely to be insertional achilles tendinopathy. It is a degenerative process that seems to be very similar to tendinopathy and like this it isn’t actually an inflammatory condition.
There are two phases that the condition goes through;
The Pain Dominant Phase
In this phase the plantar fascia is very sensitive to load and classic symptoms are that it is very stiff and painful first thing in the morning, very similar to the reactive stage in achilles tendinopathy. Walking, prolonged standing can all bring on the symptoms as such it is very likely to preclude any running during this period which will last some where between 2-8 weeks.
The Load Dominant Phase
The pain dominant phase moves onto the a load dominant phase where the pain you experience first thing n the morning or after being inactive for a while starts to decrease and you begin to be able to tolerate more activity.
During the initial painful phase we are looking to reduce the stress on the tissue to allow things to calm down and the more that this can be done the shorter the period tends to be. In cases where you might have a job that has you on your feet for long periods it is here that it tends to stretch out form a couple of weeks to more like 6-8 weeks.
In the 2nd, load dominant phase, it is here that we can look to increase the tolerance of the plantar fascia through exercise. It has been found that using heel raises and gradually increasing the weight every couple of days, again a very similar protocol to achilles tendinopathy, had a positive impact on recovery.
Why does it happen?
In the sedentary population there is a suggestion that high BMI may be a risk. Other factors such as a reduced range of movement in dorsi-flexion, the movement where you bring your foot up off the ground, and big toe extension and hamstring flexibility but none of these are definites. In terms of strength there is some link between the strength of the big toe flexor and evertor.
In athletic populations some of the above still applies but the big factor seems to be more associated with changes in training load, increased pace and or volume, and both footwear and foot strike.
Plantar Fasciopathy is definitely a tricky one to treat and can take up to 9 months to resolve in cases where it isn’t possible to really reduce the stresses that come from your job.