Plantar Fasciopathy

Question 1

What is Plantar Fasciopathy?

Answer 1

Plantar fasciopathy, often called plantar fasciitis, is a condition where the plantar fascia (a thick band of tissue under the foot) becomes irritated and painful. It commonly causes pain in the heel, especially with the first steps in the morning.

Question 2

What Causes Plantar Fasciopathy?

Answer 2

It’s usually caused by repetitive strain or overloading of the plantar fascia, often from activities like running, standing for long periods, or wearing unsupportive shoes. Tight calf muscles and a lack of foot arch support can also contribute.

Question 3

What is the Plantar Fascia?

Answer 3

The plantar fascia is a thick, fibrous band of tissue that runs along the bottom of the foot, connecting the heel (calcaneus) to the toes. It helps support the foot arch and absorb shock during walking and running.

Question 4

Why is the Plantar Fascia Susceptible to Injury?

Answer 4

The plantar fascia absorbs significant stress with every step. Repeated strain, especially in activities like running or jumping, can lead to microtears and irritation, causing pain and stiffness.

Question 5

Why Does Plantar Fasciopathy Happen?

Answer 5

“Plantar fasciopathy occurs when the fascia under your foot is overstressed without enough recovery. Over time, this leads to tiny tears and inflammation, causing pain and stiffness.”

Question 6

Flashcard 6: What is the Healing Process?

Answer 6

“The fascia heals best when we reduce excessive stress while gradually strengthening it. This will help it become more resilient and prevent future problems.”

Question 7

Setting Expectations for Recovery

Answer 7

“This condition takes time to improve. With consistent exercises, proper footwear, and gradual progression, you can expect pain relief in a few weeks to months, depending on severity.”

Question 8

Activities to Avoid with Plantar Fasciopathy

Answer 8

Avoid prolonged standing, walking barefoot, or running on hard surfaces. These activities increase strain on the plantar fascia and can delay healing.

Avoid aggressive stretching of the plantar fascia early on, as this can worsen the irritation. Instead, focus on gentle stretches and exercises that promote healing.

Question 9

Footwear Mistakes to Avoid

Answer 9

Avoid unsupportive shoes like flip-flops or high heels. Choose shoes with proper arch support and cushioning to reduce strain on the fascia.

Question 10

Subjective Assessment – Key Questions

Answer 10

• Where is the pain located? (Typically in the heel or arch).
• When does the pain occur? (Commonly worse with the first steps in the morning or after rest).
• What activities make it worse? (Prolonged standing, walking, or running).
• Any recent changes? (Increased activity levels, weight gain, or changes in footwear).
• Previous treatments? (Orthotics, stretching, rest, or other interventions tried).

Question 11

Objective Assessment – Key Tests

Answer 11

• Palpation: On the inner (medial) side of the bottom of the heel bone (calcaneus). This is where the plantar fascia originates and attaches to the heel. Press gently along the sole of the foot, from the heel toward the toes. Pain along this line indicates involvement of the plantar fascia body.
• Windlass Test: Extend the big toe while the patient stands to put tension on the plantar fascia. Pain indicates plantar fasciopathy.
• Calf Muscle Flexibility: Test for tightness, as this can increase plantar fascia strain.
• Weight-Bearing Assessment: Observe foot posture, arch height, and gait to identify biomechanical factors contributing to strain.

Question 12

Key Management Strategies

Answer 12

• Activity Modification: Reduce activities that overload the fascia, such as running or prolonged standing.
• Footwear: Wear supportive shoes with good arch support and cushioning. Consider orthotics for additional support.
• Pain Relief: Use ice to manage pain and inflammation, especially after activity.

Question 13

Long-Term Management

Answer 13

“The goal is to gradually strengthen the fascia and improve foot mechanics. Consistent exercise, proper footwear, and avoiding overloading activities are essential for long-term recovery.”

Question 14

Early-Stage Exercises for Plantar Fasciopathy

Answer 14

• Toe Curls with a Towel
• Plantar Fascia Massage with a Ball
• Calf Stretches (Wall Stretch)
• Toe Extension Stretch
• ## Seated Arch Strengthening

Question 15

Advanced Exercises

Answer 15

• Standing Heel Raises
• Resistance Band Foot Flexion

Question 16

Treatment Progression Timeline

Answer 16

• Week 0 (Start of Treatment): Begin with the core approach (education, stretching, taping).
• Weeks 2–4: Monitor progress. If the patient is improving, stick with the current plan. If recovery is not meeting expectations:
  Consider adding radial extracorporeal shockwave therapy (rESWT).
• Weeks 6–12: If recovery is still suboptimal, progress to using custom orthoses (specialised insoles for additional support).
• Weeks 12–16: For persistent symptoms, consider advanced options like injections (e.g., corticosteroids).