Plantar Fasciopathy: What do we know?

Plantar fasciitis or as we now know: fasciopathy can affect anyone. The young, the elderly, males, females. it is thought to affect people who rely on high impact work to their feet. Typically dancers and runners. The image helps us to visualise where the plantar fascia is. It attaches to your calcaneus (heel bone) and spreads to your hallux (big toe). its main role is to support your medial arch (your instep) and given your foot stability. When we dorsiflex (bend the ankle upwards) and extend (bend upwards) the big toe, as seen in the image, we put the plantar fasia under tension. Compound that with high intensity weight bearing exercise, heel pain is seemingly inevitable. For some time, it has been commonly believed that plantar fasciopathy is a long term condition, and like frozen shoulder was believed to be self-limiting, righting over time. However, over recent times, clinicians have begun to treat plantar fasciopathy with exercises and changes. You can read my blog on frozen shoulders here:

But, do any of these work? And if so, which is the best one?

A newly published systematic review of the current evidence, conducted by Huffer et al (2017) attempts to answer this. Their search identified 3 common trends in treatment

1. Switching to a minimalist shoe

2 comparisons were made. 1 shoe having no heel raise and another having a 4mm heel raise. Participants were limited to 20 - 30 miles of running per week over a 10 - 12 week period. However, because it has been widely published that long distance runners usually run in excess of 40 miles in a week, it has been suggested that any findings are not generalisable to a wider public. In addition, the trials were performed on young, elite, male athletes. Long distance runners tend to be more mature in age and have reduced balance, so is therefore not generalisable to a wider audience and it is not recommended to switch to this kind of footwear. The researchers also raised concerns regarding the safety of such footwear.

2. Intrinsic foot muscle strengthening

Any exercise that incorporates the intrinsic (originate inside the foot) muscle of the foot without activating the extrinsic (originate outside the foot) have been considered efficient in rehabilitating plantar fasciopathy. The premise is to use these muscles to strengthen and return the medial arch. Whilst the studies reviewed demonstrated an improvement in the targeted muscles, there is a lack of research into participants with plantar fasciopathy.

3. Plantar facsia loading through the achilles

By strengthening the calves, which also attach to the heel bone and blend into the plantar fascia, it is believed by strengthening the calves, helps take the strain and load from the plantar fascia. As in number 2, the studies identified only examined young, fit, elite asymptomatic participants. whilst gains were identified, it is questionable whether there is any significant benefit from performing such exercise for the rehabilitation of plantar fasciopathy.

In summary

The researchers have concluded that the current evidence in the management and rehabilitation of plantar fasciopathy is limited. Whilst gains have been shown in strengthening of the surrounding musculature, it is unclear which is more effective. yet it must be considered that the current research does not represent the true suffering population. One thing is for sure, it is not self-limiting and exercising will help. This is not something you can rest and it will go away. If you feel you have plantar fasciopathy, make sure you are assessed by a physiotherapist who is practicing with up-to-date techniques.