Plantar heel pain is a musculoskeletal disorder primarily affecting the enthesis of the plantar fascia, and is synonymous with terms such as plantar fasciitis, painful heel syndrome, heel spur syndrome, runners’ heel and plantar fasciopathy. Plantar fasciitis has been the most commonly used term for this condition, most likely due to initial beliefs that pain results from an inflammatory reaction at the fascial enthesis. It is now clearer that the condition is more commonly due to a degenerative process thus, rendering the term ‘fasciitis’ less suitable for broader use and plantar fasciopathy to be more correct. Truths: 1. It’s not inflamed so don’t bother with anti-inflammatory medication. 2. Don’t roll it with a frozen water bottle. 3. Don’t rest it.
Foot & ankle range of motion in plantar fasciopathy (Fasciitis)
As physiotherapist in Penrith assessing and treating range of motion deficits in any injury is certainly something we look to manage. And this looks to be somewhat supported by the weight of evidence from studies using valid, reliable measures supports an association being likely, particularly in general population samples.
Therefore, our physios, chiropractors and exercise physiologists consider the use of strategies aimed at improving dorsiflexion flexibility, or accommodating for restricted motion, when managing people with heel pain.
With respect to 1st metatarsalphalangeal joint, the relationship between toe range of motion and heel pain remains unclear.
The uncertainty of a custom made orthotic in the management of plantar fasciopathy (fasciitis).
Cheap off the shelf orthotics work just as well as expensive custom made ones; but both only for the short term.
The uncertainty of any link between foot posture and plantar heel pain may have some impact on management strategies that influence mechanical function of the foot, such as orthoses.
Pre-fabricated off the shelf and expensive custom orthoses have been demonstrated to be equally effective in reducing plantar heel pain, with the mechanism possibly one of offloading via support of the arch, or a reduction in pressure beneath the painful heel.
Whilst these strategies may be useful in offloading the heel and reducing pain in the short term, usage of orthoses to prevent recurring heel pain based on presenting foot posture does not appear to be supported by evidence. Ref: Sullivan J, Burns J. Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management. The Foot 2020; 42.