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A Fully Explained Guide to Managing Plantar Fasciopathy and Plantar Heel Pain

Updated: May 30

Plantar heel pain, understood as a foot disorder called plantar fasciopathy by experts, is a frequent illness endured by millions of individuals worldwide. It is a condition with pain and aching either on the inside of the heel, as in plantar fasciitis, or on the bottom of the foot, as in nocturnal leg cramps. Apart from this awareness, it is vital as it influences the performance level of people in current-day life.


Plantar fasciopathy, a type of inflammation or degeneration of the plantar fascia (a thick band of connective tissue from the heel to the toes), is a foot condition related to collagen breakdown in the fascia tissue.


Causes and Risk Factors of Foot Pain Due to Plantar Fasciopathy


The plantar fascia is subject to overuse and decreased elasticity in most situations that involve repetitive and increasing strain, which are the leading causes of plantar fasciopathy. This may result from many reasons, such as long-distance running, wrong footwear, or abruptly picking up sports dates. The plantar fascia ligament functions as the 'arch-cushion' of the foot by supporting the arch and absorbing the impact of walking and running. However, it can develop into swelling or irritation when subjected to excessive stress.



Symptoms and Diagnosis of Plantar Fasciopathy


Plantar Fasciopathy symptoms and diagnosis are characterized to be similar to plantar fasciitis. Affected patients experience a dull pain at the bottom of the foot after prolonged standing or getting out of bed in the morning.


The essential feature of plantar fasciopathy is a sharp, stab-like pain in the heels or bottom of the foot, mainly noticed when taking the first steps after sleep or prolonged sitting. The sufferer often feels pain and stiffness as well as the inability to walk with no or very little support underneath the feet. With time, the pain may become more prominent when standing for long periods or participating in physical activity, and it may spread outside the foot (in the ankle and shin).


Pinpointing plantar fasciopathy is usually initiated through a physical examination by a healthcare professional such as a podiatrist or orthopedic specialist. In this search for the diagnosis, the healthcare provider will consequently check the patient's signs and symptoms, medical history, and physical traits. In certain situations, imaging tests could be undertaken, e.g., an X-ray or MRI scan, to rule out any other causes or to confirm fasciopathy of plantar location.


One of the conservative treatment modalities for Plantar Fasciopathy is low-dose ibuprofen, which reduces inflammation and subsequent pain. This short-term use of corticosteroids can provide immediate pain relief. Still, it may come at the cost of potential side effects, mainly when used for a prolonged period.


Shockwave therapy for plantar fasciitis is often scheduled with sessions spaced 24-48 hours apart for several reasons:


1. Tissue Healing Time: The intervals between sessions allow the damaged tissue to undergo initial healing. Shockwave therapy triggers a controlled inflammatory response in the affected area, which is part of the healing process. Giving the tissue time to recover between sessions allows it to respond appropriately to the treatment and heal effectively.


2. Optimal Stimulation: The effects of shockwave therapy continue to work on the tissue for some time after each session. By spacing sessions 24-48 hours apart, it allows the body to fully respond to the treatment and for the effects to maximize their impact on the affected area.


3. Prevention of Overstimulation: Shockwave therapy involves the delivery of acoustic waves to the affected area, which can be intense. Spacing sessions apart prevents overstimulation of the tissue, reducing the risk of adverse reactions or exacerbating symptoms.


4. Clinical Experience and Research: The 24-48 hour interval between sessions is based on clinical experience and research findings, which have shown this spacing to be effective in promoting healing and reducing symptoms of plantar fasciitis.


The choice between heat and ice therapy for plantar fasciitis depends on the stage of the condition and the individual's response to each modality. While both heat and ice can provide relief, heat therapy is often preferred over ice therapy for certain reasons:


1. Increased Blood Flow: Heat therapy, such as warm compresses or heating pads, promotes vasodilation, which increases blood flow to the affected area. This increased circulation delivers oxygen and nutrients to the tissues, facilitating the healing process. In contrast, ice therapy, while effective for reducing inflammation and numbing pain, constricts blood vessels, potentially limiting blood flow.


2. Muscle Relaxation: Heat can help relax the muscles in the foot and calf, which may be tight or tense in individuals with plantar fasciitis. This relaxation can alleviate tension in the plantar fascia and surrounding tissues, reducing pain and improving flexibility. Ice therapy, on the other hand, may temporarily stiffen muscles, which could exacerbate discomfort in some cases.


3. Promotes Tissue Elasticity: Heat therapy can increase tissue elasticity, making it easier to stretch and mobilize the plantar fascia and surrounding structures. This can be particularly beneficial before engaging in stretching exercises or physical therapy for plantar fasciitis. Ice therapy, while useful for numbing pain and reducing inflammation, does not have the same effect on tissue elasticity.


4. Pre-Activity Warm-Up: Applying heat before physical activity or exercise can help prepare the foot muscles and connective tissues for movement, reducing the risk of injury and discomfort during activity. This pre-activity warm-up can be especially helpful for individuals with plantar fasciitis who engage in repetitive or high-impact activities.


5. Comfort and Relaxation: Many individuals find heat therapy to be soothing and comforting, providing a sense of relaxation and relief from pain. Heat can help alleviate muscle stiffness and tension, promoting a sense of well-being and comfort. In contrast, ice therapy may feel uncomfortable or numbing to some people, particularly if applied for extended periods.


While heat therapy may be preferred for many individuals with plantar fasciitis, it's essential to listen to your body and adjust your treatment approach based on your symptoms and preferences. Some people may find that alternating between heat and ice therapy provides the best results, while others may respond better to one modality over the other. Experimenting with different therapies under the guidance of a healthcare professional can help you find the most effective treatment strategy for managing your plantar fasciitis symptoms.


Physical therapy and manual therapy techniques: The physical therapist helps a patient with treatment techniques that can be used, such as stretches, exercises for strengthening, and manual therapy techniques to increase the patient's foot flexibility, strength, and overall foot function.

  

Shockwave therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a non-invasive treatment option for various musculoskeletal conditions, including plantar fasciitis. Plantar fasciitis is a common foot condition characterized by pain and inflammation in the plantar fascia, a thick band of tissue that runs along the bottom of the foot.


Here's how shockwave therapy helps with plantar fasciitis:


1. Stimulates Healing: Shockwave therapy delivers high-energy acoustic waves to the affected area. These waves create microtrauma in the tissue, stimulating the body's natural healing response. This process promotes blood flow, increases cell regeneration, and accelerates tissue repair in the plantar fascia.



2. Reduces Pain: By stimulating tissue repair and regeneration, shockwave therapy can help reduce inflammation and alleviate pain associated with plantar fasciitis. It also disrupts pain pathways, providing temporary relief and improving overall comfort.


3. Breaks Down Scar Tissue: In chronic cases of plantar fasciitis, scar tissue may form in the plantar fascia, contributing to pain and stiffness. Shockwave therapy helps break down this scar tissue, promoting better tissue flexibility and reducing the likelihood of recurrence.


4. Improves Mobility: Pain and stiffness associated with plantar fasciitis can limit mobility and affect daily activities. Shockwave therapy aims to improve range of motion in the foot by reducing pain and inflammation, allowing patients to move more comfortably and resume normal activities.


5. Non-Invasive and Low-Risk: Compared to surgical interventions, shockwave therapy is non-invasive and carries fewer risks. It typically involves a series of sessions performed on an outpatient basis, with minimal downtime and no need for anesthesia.


It's important to note that while shockwave therapy can be effective for many patients with plantar fasciitis, individual responses may vary. Some people may experience significant pain relief and improvement in symptoms, while others may require additional treatments or a combination of therapies for optimal results. Additionally, shockwave therapy is usually recommended after conservative treatments such as rest, stretching exercises, orthotic devices, and physical therapy have been tried without success. Always consult with a healthcare professional to determine the most suitable treatment approach for your specific condition.


Whether to go more into injection therapies or surgery


In certain instances, conservative tactics may prove ineffective in resolving plantar fasciopathy; therefore, additional interventions are part of the treatment plan. These include:


Injection therapy: If conservative treatment modalities (e.g., painkillers and anti-inflammatory drugs) fail to relieve symptoms within the expected healing time, healthcare providers will apply injection therapy (corticosteroid injections) to the patient. One of the roles these injections play is to lessen inflammation and, therefore, alleviate the pain in the short term. However, they are primarily utilized as a short-term remedy, so they do not look far enough into the real cause of the condition.



Surgical options: When conservative treatment with an injection, although provided insufficient culmination of the symptom, or the situation has become chronic and disabling, a surgical procedure may be performed. Surgical procedures for treating plantar fasciopathy may include releases or partial detachment of the plantar fascia or other interventions, such as removing the spur bones or nerve compression.


Lifestyle Modification and this self-practice guideline


Besides the note in my lifestyle mentioned above, I will start by organizing daily activities and routines to minimize the strain on the plantar fascia. Such modification could stipulate a specific limit on standing and walking, allowing for more breaks and using swimming or cycling to supplement exercise when needed.


By applying simple self-management techniques like applying colds to the affected location, performing self-massage, and using non-prescription pain relievers, the symptoms of plantar fasciopathy can be governed. These modalities are non-invasive and may give momentary pain relief. They can be employed together with other strategies, namely stretching, strengthening exercises, and the use of orthotics or supportive footwear.


One thing worth mentioning is the fact that the proposed lifestyle changes and self-management techniques should always be coupled with the guidance given by a professional healthcare provider. A healthcare specialist can then use their expertise to offer personalized advice and suggest a course of action that will most efficiently manage the condition.

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