The Plantar Fascia

The plantar fascia ligament helps support the bones of your foot and absorb the loading forces associated with standing, walking, and running. Heel pain associated with the plantar fascia and plantar fasciosis can be quite disabling.

For many people, heel pain of plantar fascia origin is at its worst first thing in the morning. Symptoms are also commonly aggravated when rising and moving after sitting or standing still for sustained periods.

Pain in this situation is most commonly experienced under the heel bone (the calcaneus). However, some individuals experience pain associated with the plantar fascia in the arch of their foot, or even on the outer aspect of the foot and heel area.

Occasionally, mild swelling or redness may occur. More commonly, people experience tenderness on palpation of the bottom of the heel, coupled with difficulty walking comfortably.

Plantar Fasciitis Or Plantar Fasciosis, What Is The Difference?

Plantar fasciitis refers to the inflammatory stage of plantar fascia associated heel pain, whereas plantar fasciosis refers to the degenerative phase of plantar fascia associated heel pain.

Microscopic stretching, tearing, and degeneration of the plantar fascia can occur at its attachment site during plantar fasciosis. This attachment point is where the plantar fascia connects to the calcaneus.

Plantar Fasciopathy The Blanket Term

Degeneration associated with plantar fasciosis often develops due to repetitive stress following on from plantar fasciitis.

Over time, many cases of plantar fasciitis progress into plantar fasciosis. As a result, plantar fasciopathy is often considered the most appropriate term for plantar fascia heel pain.

Plantar fasciopathy can include:

• Initial inflammatory stages around the onset of pain
• Chronic degenerative phases
• Acute flare-ups of a chronic condition

During flare-ups, acute inflammation may be present within the plantar fascia. This can occur on top of a more chronic degenerative issue.

Management of heel pain and plantar fascia pain often differs depending on whether the condition is inflammatory or degenerative in nature.

Because of this, identifying the stage of the condition early is important before treatment begins.

Heel Spurs

An X-ray may sometimes highlight the presence of a bone spur. In some cases, this spur may then be implicated as a contributor to heel pain.

A heel spur is generally considered evidence that excessive force has been placed through the plantar fascia onto the heel bone over time.

Calcium deposition within the plantar fascia adjacent to the heel bone results in heel spur formation.

From a clinical perspective, patients with heel spurs often require a longer rehabilitation period before symptoms fully settle.

Extended rehabilitation timeframes may reflect both the duration and severity of stress that has been placed on the plantar fascia over time.

Differential Diagnosis For Heel Pain

Correct diagnosis of heel pain by a physiotherapist or podiatrist is important.

Several conditions can present in a similar way to plantar fasciopathy, so assessment helps guide the right treatment approach.

In most cases, plantar fasciopathy will resolve without the need for cortisone injections, surgery, or other invasive treatments.

Conservative management may include:

• orthotics
• taping techniques
• Stretching and strengthening exercises
• Acupuncture / dry needling
• Massage and soft tissue techniques
• Joint mobilisations

These approaches are usually enough to get on top of plantar fascia associated heel pain.

Radial Shockwave Treatment And Plantar Fasciosis

During the plantar fasciosis stage, one treatment approach we have found useful at Sydney Physio Clinic is radial shockwave treatment.

Shockwave therapy is commonly used in the management of chronic tendinopathies and plantar fasciopathy.

Helping stimulate the body’s natural healing response, this treatment may assist with chronic soft tissue complaints and heel spur associated pain.

Our radial shockwave therapy machine can easily be incorporated into an individual’s plantar fasciopathy rehabilitation program for the treatment of chronic heel pain.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, or products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Plantar Fasciosis Versus Plantar Fasciitis should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist, or physiotherapist.