Plantar fasciopathy (PF) is an acute or chronic, painful disorder of the plantar fascia that spans between the medial calcaneal tubercle and the proximal phalanges of the toes.
It is the most common cause of plantar heel pain and accounts for approximately 11-15% of foot symptoms presenting to physicians. The main clinical symptom is heel pain, particularly in the morning or after a period of rest. Often patients report improvement of pain after walking. Pain is usually located at the origin of the plantar fascia, i.e., at the medial calcaneal tubercle. Passive dorsiflexion of the toes may aggravate the pain in some patients, particularly in those with chronic PF. Patients suffering from chronic PF may also present with heel pad swelling.
Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of plantar heel pain or to establish the diagnosis of PF when in doubt. Histologic examination of biopsy specimens from patients undergoing plantar fascia release surgery for chronic symptoms has shown that chronic PF is associated with degenerative changes in the fascia.
Accordingly, the disease is better characterized as “fasciopathy” than “fasciitis”, resembling the situation in overuse tendon problems.
In the United States, more than two million individuals are treated for PF on an annual basis. Up to 10% of the population will experience plantar heel pain during the course of a lifetime.
Both athletes and the elderly commonly present to physicians with PF. The treatment of PF should start with conservative treatment modalities including rest, physiotherapy, stretching, exercises, shoe inserts/orthotics, night splints, non-steroidal anti-inflammatory drugs, and local corticosteroid injections. Patients not responding to conservative treatment for six months (between 10% and 20% of all patients) shall then undergo radial shock wave therapy (RSWT). Surgery should be considered for recalcitrant cases of PF.