Justin Coulter’s current thoughts on Plantar Fasciopathy

February 13th, 2015 by Justin Coulter


 Justin Coulter is a leading musculoskeletal podiatrist in London and in this article he discusses his current thoughts on Plantar Fasciopathy including symptoms and treatment options.

Plantar fasciitis is a very common condition in orthopaedic medicine accounting for 15% of all adult foot complaints. It affects both the athletic and non-athletic populations and will affect 10% of the population at some point in their life. In the athletic population, it accounts for 8% of all running injuries and in the non-athletic population it is usually seen in someone who is on their feet a lot, possibly overweight and more likely to present after their 50’s.

The ‘itis’ in plantar fasciitis refers to inflammation of the fascia which is a thick fibrous band that runs under the foot. However, there is little evidence that inflammation is the primary problem and hence the term fasciopathy or fasciosis. Degeneration of the attachment of the fascia to bone is very common and usually occurs from forces that exceed the tolerance of the fascia to resist that load. For example, if you were to increase activity rapidly or put on weight it may tip the fascia into an injured state. There are, of course, numerous and sometimes multiple contributing factors that can lead to the condition.

Classic symptoms of plantar fasciopathy include pain in the heel upon rising in the morning which improves after a few minutes. This may return towards the end of the day or when getting up from a seated position. This can progress, if untreated, to pain throughout the day. There is usually no pain at night.

The problem is self limiting but can take over 12 months to resolve! However, if one treats it early it can respond quite quickly. Treatments include strapping, stretching, foot orthoses (arch conforming insoles), night splints, physiotherapy and sometimes cortisone injection. For the more persistent cases, shock wave therapy (ESWT) can be considered aimed at encouraging the body’s own healing mechanisms.