For those of us who’ve encountered plantarfasciopathy, the first-hand experience reveals its debilitating and exasperating nature.
“Each morning mirrors the sensation of walking on shards of glass, swiftly transforming your mood into one of irritability and dissatisfaction”.
Formerly identified as plantar fasciitis, plantar fasciopathy is the updated term. The shift arises from the realisation that “itis” denotes inflammation, and since the plantar fascia lacks a blood supply, inflammation isn’t the primary process in this condition. Instead, the accepted term for issues related to tendons and fascia is “opathy.”
The onset of plantar fasciopathy typically results from alterations in the loads borne by the foot. Various factors, such as the choice of footwear, foot structure, overuse, and the characteristics of walking surfaces can contribute to its development.
The condition commonly manifests as a stabbing pain, particularly during the initial steps taken in the morning. While the pain tends to diminish with movement, it may resurface after extended periods of standing or upon standing up following a period of sitting.
The initial stage of plantar fasciopathy is a pain dominant stage. Characterised by early morning symptoms and reduced tolerance of daily activities. The duration of this is usually 6-8 weeks.
- Reduce the impact: if suffering from heel pain, shock absorbing shoes assist to reduce the load going through the plantar fascia and help reduce the pain.
- Rest the tissues: avoid high activity and strain.
- Ice 10-20 minutes 2-3 times per day
- Trigger point release ball over the base of the foot
- Toe spacers with a focus on improving big toe movement. https://www.wit-fitness.com/products/toe-spacer
- Anti- inflammatory medication: a short course of ibuprofen can assist to alleviate pain & reduce inflammation. This should be discussed prior to use with GP.
- Weight management: reduction of excess stress on the feet.
- A focus on flexibility lead by physiotherapist with a focus not on overstretching.
- A physiotherapy led exercise programme with an emphasis initially on flexibility whilst avoiding any excessive stretching.
- Manual modalities (hands on physiotherapy) can be useful here for providing symptom relief in the initial phases.
Next is the load dominant stage where the plantar fascia is ready to take loading with graded exercise to strengthen it. This stage can continue for 18 months but often is not painful.
- Similar to how tendinopathy is addressed, high-load strength training seems to be a successful approach in managing plantar fasciopathy. Engaging in high-load strength training may contribute to a faster alleviation of pain and enhancements in functionality.
- Highlighting high-load activities is believed to trigger adaptive responses in the tissues, fostering tissue remodeling and enhanced resilience. It is advisable to undertake these exercises under the supervision of a physiotherapist. This allows for the customization of exercises based on an individual’s specific condition, taking into account factors such as severity, overall fitness level, and underlying biomechanical issues.
- If the problem does not show improvement with traditional physiotherapy methods, shockwave therapy may prove beneficial for more resistant cases. This advanced therapeutic approach can be particularly effective in addressing stubborn or persistent issues.