Plantar Fasciopathy
Plantar Fasciopathy
Embedded Files
The plantar fascia is a strong fibrous band that stretches from the heel to your toes. It is made up of three bands that run along the inside, middle and outside of the bottom of your foot. The inside and outside bands support the arch and act as shock-absorbers. Shock absorption is important as it reduces the impact your body weight has on the foot when walking, running and carrying out any weight-bearing exercises. Not only does the plantar fascia support the arch, but it also stabilizes the foot to allow you to push off through your toes.
Patient Signs and Symptoms
Patient Signs and Symptoms
Isolated plantar heel pain (patient knows generally where it hurts)
Pain described as sharp or aching
Pain on weight-bearing first thing in morning or following periods of rest
Pain decreases after initial post rest pain then returns after longer periods of time of feet
Gradual (insidious) onset
Significant Findings
Significant Findings
Significant ADL impact
History of sudden increase in exercise or prolong standing in occupation/hard floors
Overuse injury
Returning back to sport activity/ change of job
Deconditioned background/reduced strength capacity
Generally Pain on palpation of medial tuberosity with/without inflammation of the calcaneus but can occur anywhere more distal to insertion
Palpation pain exacerbated by increased dorsiflexion of ankle and lesser toes
Increase in age (40-60) and BMI (>30 kg/m2)
Abnormal foot posture index score
Restricted ankle dorsiflexion
Possible Achilles Tendinopathy pain
Decreased Hamstring flexibility
Decreased functional range of motion of 1st metatarsophalangeal joint during gait
Unsupportive/flat/ worn-out footwear
Imaging
Imaging
Not indicated at initial assessment/diagnosis of plantar heel pain but may be indicated for differential diagnosis if fails to settle. Diagnosis made by clinical signs as typically indicate accurate diagnosis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Findings suggestive of alternative diagnosis
Findings suggestive of alternative diagnosis
Abnormal neurology (radiating pain, power loss, paraesthesia/ Anaesthesia, reflex changes)
History of trauma and diffuse symptoms
History of inflammatory arthritis (significant joint swelling, morning stiffness widespread pain or history of inflammatory arthritis)
Posterior heel pain ath the ankle/lower leg pain
Progressive change in foot posture
Prolonged rest pain
Calcaneal spurs do not correlate with symptoms
Differential Diagnosis
Differential Diagnosis
Posterior heel pain
Fat pad Atrophy
Posterior Tibial Tendon dysfunction
Inflammatory (Rheumatoid Arthritis/ Gout/ Psoriatic Arthritis/ Juvenile Idiopathic Arthritis).
Bilateral heel pain may be suggestive of underlying Spondyloarthropathy. (Ask regards history of back pain, morning stiffness, joint pains, psoriasis may be present)
Calcaneal Apophysitits (6-14 year olds)
Referred from lower back (L5/S1 nerve pathology)
Local nerve entrapment (Paraesthesia, burning and tingling sensation, tenderness along the course of the nerve, positive neural provocation tests)
Trauma/ stress fracture (Diffuse heel pain, exacerbated by activity, swelling and redness of overlying skin, calcaneal tenderness)
Skin pathology (corn)
Rupture (sudden onset, tearing, or ripping pain in mid foot or hind-foot, bruising/ sub hematoma, activity can be intolerable)
Plantar fibromatosis
Critical limb ischaemia
Avascular necrosis
Infection (Fever, malaise, fatigue, weight loss)
Bone insufficiency (Osteoporosis/ long term steroid use)
Neoplasm/ space occupying lesion (deep bone pain, increased nocturnal pain)
Treatment not currently recommend based on evidence
Treatment not currently recommend based on evidence
Trigger point dry needling
Acupuncture
Therapeutic Ultrasound
Platelet Rich Plasma (PRP) injections
Low level laser
First line treatment options
First line treatment options
Page updated
Google Sites
Report abuse