Plantar faciopathy is a common painful condition that affects the underside of the foot. The condition can occur in people of all age groups, though is most common in women 40-60 years of age. This condition progresses along a predictable clinical course of acute, subacute and chronic stages.
In the acute stage, sharp foot pain occurs on the inside of the heel and is usually at its worst in the mornings. This improves throughout the day as the tissue warms up where pain is then replaced by a dull ache that improves with rest.
The initial cause could have been a change in footwear, an increase in training volume or change of surface, a new sport that involves different loading to the foot muscles or a reduction in range of motion of the foot and ankle due to muscle tightness of the lower limbs. Most active people continue to train or carry on with their normal routines in the hope that their symptoms will settle in this stage without seeking treatment.
In time and with further aggravation, heel pain progressively increases to the sub-acute stage where activities that have not caused pain in the past do so and the dull ache continues even at rest. The pain has an impact of the amount of exercise an individual can complete and sufferers become aware of their symptoms every day. This is the stage where most of our plantar fasciopathy clients present to the clinic.
In chronic stages of plantar fasciopathy degenerative changes to the tissue occurs with symptoms easily exacerbated with weight bearing movement. 70% of patients will have a heel spur that can be seen on x-ray in this stage.
Myotherapists will aim to provide a working diagnosis through a thorough assessment of patient history, assess the predisposing factors and the biomechanics that could have lead to the onset of symptoms, palpate the underside of the foot for the local tenderness and assess for movements that may cause pain. Once the Myotherapist has established the stage of the condition, they will assist the patient with treatment, advice and corrective exercises to help control pain and improve the functioning of the affected tissues.
Treatment from your Myotherapist will involve manual therapy to the plantar fascia, calf and hamstring muscles to help reduce muscle tightness that can decrease range of motion of the ankle leading to the onset of symptoms. They will also prescribe exercises that can help strengthen muscles of the foot, calf and hip to improve stability and the ability of the body to adapt to varying loads.
Depending on the stage of the condition, there is evidence for stretching, the inclusion of arch supports and heel cushions, taping to off-load the foot and high-load strengthening exercises that can be completed at home or in the gym to allow the tissue to adapt to the demands we place on them every day. Slow progressions back into normal exercise routines along with specific strengthening exercises and treatment compliance are key to the resolution of plantar fasciopathy symptoms.
By Shaun Bryce – Elite Myotherapist