What’s Really Wrong? « Plantar Fasciitis and Plantar Fasicopathy (Heel Pain)

Plantar Fasciitis and Plantar Fasicopathy (Heel Pain)

What’s Really Wrong?

What causes plantar fasciitis?:

When the plantar fascia becomes over-stretched, injured or over-used it can begin to hurt. The exact cause of plantar fasciitis and plantar fasciopathy is not well understood. However, when there is too much stress on a band of tissue (a tendon, a ligament or the plantar fascia) from overuse, or from a sudden change in use that traumatizes the tissue, that can result in degeneration (becoming broken or worn down). In addition, there can be injury-related, disease-related or age-related changes in the plantar fascia that may also lead to degeneration. Researchers examined the tissue from patients with chronic plantar fasciitis and found that the tissue consistently showed degeneration1. This is very important, because previously all plantar fasciitis was often considered an inflammatory condition (where the body’s immune system is actively engaging a perceived threat). Even after the important discovery that chronic plantar fasciitis is degenerative, many are still treating chronic plantar fasciitis as if it were inflammatory.

Historical thinking:

Historically, most health care providers and lay people have used the term "plantar fasciitis" to apply to many painful conditions of the plantar fascia, including longer term plantar fascia problems which would more correctly be called plantar fasciosis (indicating degeneration). By definition, the suffix "itis" indicates inflammation or an active inflammatory process. With this in mind, conventional management often was, and still is, aimed at reducing or controlling the inflammatory process (rest, ice, anti-inflammatory medications, splinting, immobilization, etc.). Although acute (sudden, short term) cases of plantar fascia disorders may have a significant element of inflammation, those that last longer (chronic, meaning greater than 6-12 weeks), do not have much, if any, inflammation present1,2. Most cases of chronic plantar fasciitis are resistant to treatments that try to reduce inflammation. What is often seen with these conventional anti-inflammatory treatments is that during the treatment process the patient’s activity is usually limited and the patient may feel a little better. However, once they return to the activity, the symptoms return. This sets up a vicious cycle of taking time off from activity to decrease symptoms, followed by a return of symptoms when activity is resumed.

Latest research and science:

We now know that chronic plantar fasciitis and chronic tendinopathies are mainly degenerative (worn or broken down) in nature rather than inflammatory1,2,3; there is rarely any inflammation present in the involved plantar fascia or the involved tendon. That is why treatments that focus on trying to reduce inflammation don’t have much of an effect. The problem is that most treatments have not caught up with the latest research showing us that the cause of most chronic cases of plantar fasciitis are due to the degeneration, or a wearing/breaking down of the plantar fascia. We now know that in order to effectively treat chronic plantar fasciitis, the focus must be on regenerating or re-healing plantar fascia rather than on reducing inflammation.