For century’s terms such as gonorrhoeal heel, Policeman’s heel, jogger’s heel, plantarfasciitis and plantarfasciopathy have all been used to describe pain under the heel. This reflects the evolving nature of our understanding of this condition. Many victims are now having their half and full marathon dreams cut short or perhaps giving up on those New Year resolutions activities due to heel pain.
Plantarfasciitis suggests inflammation, (‘itis’ in medicine means inflammation) which can be misleading as its more tissue degradation rather than an inflammatory condition. Plantarfasciopathy is a more appropriate, modern terminology.
Does this really make a difference in what we call it? Well if we think inflammation we may well treat it that way – take anti-inflammatory medications, use cold packs, rest up, have an anti-inflammatory steroid injection. More accurate terminology helps individuals to understand why they have pain and how best to recover, why it’s really important to be given specific exercises. Plantarfasciopathy as we should refer to it, is similar to tendon pathologies where it’s about load management and load capacity issues. Often it develops when an individual increases their load, usually by increasing running, walking or time on their feet and the plantar fascia – a tough fibrous tissue on the bottom of the foot giving support and helping us propel forwards – fails to cope with this demand.
Plantarfasciopathy can affect active and sedentary individuals and has a range of risk factors. High weight and reduced flexibility in ankle and big toe joints are the main risk factors. A sudden change or increase in activities such as running, walking or time spent on feet have been identified as major risk factors.
Symptoms typically present as pain and stiffness in the bottom of the heel towards the inside of the foot. Often worse in the mornings with the first few steps and after prolonged rest or activity.
The initial stage of plantarfasciopathy is a pain dominant stage. Characterised by early morning symptoms and reduced tolerance of daily activities/sport. The duration of this phase is variable and difficult to predict but may last up to 6-8 weeks. Treatment at this stage is focused on settling the pain. Next is the load dominant stage where the plantar fascia is ready to take loading (graded specific exercises) to strengthen it. This stage can take 18 months but often isn’t painful. However, its still really important to continue those exercises to build full strength in the tissue.
The good news is that plantarfasciopathy does often get better with appropriate treatment and is not a self-limiting condition as previously thought. The ‘watch and see’ approach, may not be the best option, there is so much more to help the condition and reduce the chances of its return.
It is always best to have a thorough assessment by an appropriate clinician such as a physiotherapist. This is particularly important to help rule out other conditions affecting the heel and to understand why you got it in the first place and help ensure it doesn’t come back to bite you in the heel!