Plantar Fasciitis (Fasciopathy)

Plantar fasciitis is a painful, often disabling chronic condition accounting for 15% of adult foot complaints and affecting 10% of the population at some time in their life. (Irving et at, 2008; Irving, Cook & Menz, 2006; Rome, 1997). The condition is degenerative in nature and as there is infrequently inflammation involved, plantar fasciopathy is a more appropriate terminology.

The central band of the plantar fascia attaches to the medial process of the calcaneal tuberosity, the area is covered by the calcaneal fat pad and also provides attachments for  Flexor digitorum brevis (FDB), Abductor hallucis (AH), and the medial head of Quadratus plantae (QP) (Tahririan et al, 2012). This attachment point can be referred to as the enthesis, with patients occasionally experiencing pain on palpation of the area, but more commonly referring to the area as the point of pain. There can be radiation of the pain, with heel edge pain being associated with Baxter’s nerve entrapment (Alshami, 2008) though other neurological factors should be considered

 Your North East Foot Centre Podiatrist will diagnose the condition

Differential diagnosis with these structures should be considered, (Thomas, 2010), with fat pad atrophy and consequential calcaneal bony oedema being a frequent misdiagnosis. (Hossain & Makwana, 2011)

Differential diagnoses of heel Pain can be classified into structural, Neurological, Metabolic, Neoblastic (cancerous) and inflammatory.

Stuctural

Neurological

Metabolic

Neoblastic

Inflammatory

Insertional Plantar Fasciopathy

Baxter’s nerve entrapment

Osteomalacia

Unicameral bone cyst

Osteomyelitis

(Infection)

None insertional Plantar Fasciopathy

Medial calcaneal nerve entrapment

Paget’s disease

Intraosseous lipoma

Seronegative arthropathy

Plantar Fascia rupture

Tarsal tunnel syndrome

Hyperparathyroidism

Aneurysmal bone cyst

Inflammatory bowel disease

Calcaneal oedema

S1 radiculopathy

 

Osteoid osteoma

Gout

Calcaneal stress fracture

 

 

Giant cell tumour

Rheumatoid arthritis

Plantar heel bursitis

 

 

Metastatic tumour

 

Calcaneal fat pad atrophy or trauma

 

 

Osteogenic sarcoma

 

Flexor hallucis longus tendinitis

 

 

Chondrosarcoma

 

 

 

 

Ewing’s sarcoma

 

 

Then we will consider first treatment measures, including taping, activity management, exercise therapy, cushioning, pain management including acupuncture, footwear and foot orthoses

Initial taping can be an assistive in this differential diagnosis as well as giving early relief. This could be in the form of heel fat pad retention taping of full low-dye taping. Modest relief of symptoms using the first method with greater improvement of symptoms with full taping would be diagnostic of Plantar Fasciopathy.

There is a justification for orthotic management that is well cited in the literature, with the pronated foot and pathological traction load on the plantar fascia implicated (Bogla & Malone, 2004; Irving et al, 2007). 

Reduction of compression and traction to the heel has been extensively debated in the literature, with compressive factors being significant in the presence of a calcaneal spur (Menz et al, 2008). However weakness of muscles, particularly the foot everters has been cited ( Latey et al,2014). It follows that successful orthotic management of Plantar Fasciopathy has a combination of easing the stress on the foot plantar flexors whilst reducing traction loads 

 

 

Alshami, A. M., Souvlis, T. and Coppieters, M. W. (2008) ‘A review of plantar heel pain of neural origin: Differential diagnosis and management’, Manual Therapy. doi: 10.1016/j.math.2007.01.014.

Bartold, S. J. (2004) ‘The plantar fascia as a source of pain - Biomechanics, presentation and treatment’, Journal of Bodywork and Movement Therapies, 8(3), pp. 214–226. doi: 10.1016/S1360-8592(03)00087-1.

Bolgla, L. A. and Malone, T. R. (2004) ‘Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice’, Journal of Athletic Training.

Burns, J. et al. (2005) ‘The effect of pes cavus on foot pain and plantar pressure’, Clinical Biomechanics. doi: 10.1016/j.clinbiomech.2005.03.006.

Hossain, M. and Makwana, N. (2011) ‘“Not Plantar Fasciitis”: The differential diagnosis and management of heel pain syndrome’, Orthopaedics and Trauma. doi: 10.1016/j.mporth.2011.02.003. Lermagazine.com. (2018).

Evidence-based use of metatarsal pads | Lower Extremity Review Magazine. [online] Available at: https://lermagazine.com/cover_story/evidence-based-use-of-metatarsal-pads [Accessed 7 Dec. 2018].

Irving, D.B, Cook, J.L, Young ,M, Menz, H.B., (2008) ‘ Impact of chronic plantar heel pain on health-related quality of life’. Journal of the American Podiatric Medical Association 98, 283–9. doi:10.7547/0980283

Irving, D. B. et al. (2007) ‘Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study’, BMC Musculoskeletal Disorders, 8, pp. 1–8. doi: 10.1186/1471-2474-8-41.

Irving, D. B., Cook, J. L., & Menz, H. B. (2006). Factors associated with chronic plantar heel pain: a systematic review. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2006.02.004

Menz, H. B. et al. (2008) ‘Plantar calcaneal spurs in older people: Longitudinal traction or vertical compression?’, Journal of Foot and Ankle Research, 1(1), pp. 1–7. doi: 10.1186/1757-1146-1-7.

Redmond, A. C., Crane, Y. Z., & Menz, H. B. (2008). Normative values for the Foot Posture Index. Journal of Foot and Ankle Research, 1(1), 1–9. https://doi.org/10.1186/1757-1146-1-6

Tahririan, M. A., Motififard, M., Tahmasebi, M. N., & Siavashi, B. (2012). Plantar fasciitis. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 17(8), 799-804.

Thomas, J. L. et al. (2010) ‘The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline-Revision 2010’, Journal of Foot and Ankle Surgery. doi: 10.1053/j.jfas.2010.01.001.

Yolanda Aranda and Pedro V. Munuera (2014) Plantar Fasciitis and Its Relationship with Hallux Limitus. Journal of the American Podiatric Medical Association: May 2014, Vol. 104, No. 3, pp. 263-268.

 

Plantar fasciitis is a painful, often disabling chronic condition accounting for 15% of adult foot complaints and affecting 10% of the population at some time in their life. (Irving et at, 2008; Irving, Cook & Menz, 2006; Rome, 1997). The condition is degenerative in nature and as there is infrequently inflammation involved, plantar fasciopathy is a more appropriate terminology.
The central band of the plantar fascia attaches to the medial process of the calcaneal tuberosity, the area is covered by the calcaneal fat pad and also provides attachments for Flexor digitorum brevis (FDB), Abductor hallucis (AH), and the medial head of Quadratus plantae (QP) (Tahririan et al, 2012). This attachment point can be referred to as the enthesis, with patients occasionally experiencing pain on palpation of the area, but more commonly referring to the area as the point of pain. There can be radiation of the pain, with heel edge pain being associated with Baxter’s nerve entrapment (Alshami, 2008) though other neurological factors should be considered

Differential diagnosis with these structures should be considered, (Thomas, 2010), with fat pad atrophy and consequential calcaneal bony oedema being a frequent misdiagnosis. (Hossain & Makwana, 2011)
Differential diagnoses of heel Pain can be classified into structural, Neurological, Metabolic, Neoblastic (cancerous) and inflammatory.
Stuctural Neurological Metabolic Neoblastic Inflammatory
Insertional Plantar Fasciopathy Baxter’s nerve entrapment Osteomalacia Unicameral bone cyst Osteomyelitis
(Infection)
None insertional Plantar Fasciopathy Medial calcaneal nerve entrapment Paget’s disease Intraosseous lipoma Seronegative arthropathy
Plantar Fascia rupture Tarsal tunnel syndrome Hyperparathyroidism Aneurysmal bone cyst Inflammatory bowel disease
Calcaneal oedema S1 radiculopathy Osteoid osteoma Gout
Calcaneal stress fracture Giant cell tumour Rheumatoid arthritis
Plantar heel bursitis Metastatic tumour
Calcaneal fat pad atrophy or trauma Osteogenic sarcoma
Flexor hallucis longus tendinitis Chondrosarcoma
Ewing’s sarcoma

Initial taping can be an assistive in this differential diagnosis as well as giving early relief. This could be in the form of heel fat pad retention taping of full low-dye taping. Modest relief of symptoms using the first method with greater improvement of symptoms with full taping would be diagnostic of Plantar Fasciopathy, with the reverse (*Podfo prescription- minimal heel expansion for fat pad retention)
There is a justification for orthotic management that is well cited in the literature, with the pronated foot and pathological traction load on the plantar fascia implicated (Bogla & Malone, 2004; Irving et al, 2007). (* Podfo prescription, medial posting with arch stiffener).
Reduction of compression and traction to the heel has been extensively debated in the literature, with compressive factors being significant in the presence of a calcaneal spur (Menz et al, 2008). However weakness of muscles, particularly the foot everters has been cited ( Latey et al,2014). It follows that successful orthotic management of Plantar Fasciopathy has a combination of easing the stress on the foot plantar flexors whilst reducing traction loads (* Podfo prescription flexible for athletic or low body mass, semi-flexible in the sedentary or high body mass with both plantar fascia groove).
Where the symptomatic foot has a mobile plantar-flexed first metatarsal, there will be an association of early engagement of the windlass mechanism, with resultant functional hallux limitus. Limited dorsiflexion of the hallux, that would occur in this instance, has been shown to be associated with plantar fasciopathy (Yolanda & Munuera, 2014) (* Podfo prescription, progressive flex 1st ray).
In the instance of a rigid or stiff 1st ray that will not dorsiflex above the 2nd metatarsal midline pain can result in the heel and a reduction in peak pressures to key areas is desirable ( Burns et al, 2005). In this foot type, early supination, via a combination of a bony supinatory moment in the rigid type, with early windlass engagement in the stiff type can increase traction forces (Bartold, 2004). (*podfo prescription , lateral progressive flex met bar)

The Podfo prescription of Semi-flexible or flexible Podfo sumo, arch rearfoot stiffener, lateral progressive flex met bar, with minimal heel expansion, consideration of a plantar fascia groove, progressive flex 1st ray is all based on the above research and experience of our lead clinician David Eardley

Alshami, A. M., Souvlis, T. and Coppieters, M. W. (2008) ‘A review of plantar heel pain of neural origin: Differential diagnosis and management’, Manual Therapy. doi: 10.1016/j.math.2007.01.014.
Bartold, S. J. (2004) ‘The plantar fascia as a source of pain - Biomechanics, presentation and treatment’, Journal of Bodywork and Movement Therapies, 8(3), pp. 214–226. doi: 10.1016/S1360-8592(03)00087-1.
Bolgla, L. A. and Malone, T. R. (2004) ‘Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice’, Journal of Athletic Training.
Burns, J. et al. (2005) ‘The effect of pes cavus on foot pain and plantar pressure’, Clinical Biomechanics. doi: 10.1016/j.clinbiomech.2005.03.006.
Hossain, M. and Makwana, N. (2011) ‘“Not Plantar Fasciitis”: The differential diagnosis and management of heel pain syndrome’, Orthopaedics and Trauma. doi: 10.1016/j.mporth.2011.02.003. Lermagazine.com. (2018).
Evidence-based use of metatarsal pads | Lower Extremity Review Magazine. [online] Available at: https://lermagazine.com/cover_story/evidence-based-use-of-metatarsal-pads [Accessed 7 Dec. 2018].
Irving, D.B, Cook, J.L, Young ,M, Menz, H.B., (2008) ‘ Impact of chronic plantar heel pain on health-related quality of life’. Journal of the American Podiatric Medical Association 98, 283–9. doi:10.7547/0980283
Irving, D. B. et al. (2007) ‘Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study’, BMC Musculoskeletal Disorders, 8, pp. 1–8. doi: 10.1186/1471-2474-8-41.
Irving, D. B., Cook, J. L., & Menz, H. B. (2006). Factors associated with chronic plantar heel pain: a systematic review. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2006.02.004
Menz, H. B. et al. (2008) ‘Plantar calcaneal spurs in older people: Longitudinal traction or vertical compression?’, Journal of Foot and Ankle Research, 1(1), pp. 1–7. doi: 10.1186/1757-1146-1-7.
Redmond, A. C., Crane, Y. Z., & Menz, H. B. (2008). Normative values for the Foot Posture Index. Journal of Foot and Ankle Research, 1(1), 1–9. https://doi.org/10.1186/1757-1146-1-6
Tahririan, M. A., Motififard, M., Tahmasebi, M. N., & Siavashi, B. (2012). Plantar fasciitis. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 17(8), 799-804.
Thomas, J. L. et al. (2010) ‘The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline-Revision 2010’, Journal of Foot and Ankle Surgery. doi: 10.1053/j.jfas.2010.01.001.
Yolanda Aranda and Pedro V. Munuera (2014) Plantar Fasciitis and Its Relationship with Hallux Limitus. Journal of the American Podiatric Medical Association: May 2014, Vol. 104, No. 3, pp. 263-268.