what is PLANTAR FASCIopathy?
Causes and treatments to resolve pain from Plantar Fasciopathy
( Plantar Fasciitis )
The plantar fascia is connective tissue that connects the heel to foot muscles and supports the arch of the foot. A combination of over use and micro-damage of the fascia from excessive stress can contribute to plantar fasciopathy. They use to call this tendonitis which is “inflammation”, but we know that it is not usually inflammation but a certain amount of excessive stress to the tendon that causes the injury to the tendon which we call plantar fasciopathy.
How do I know if I have plantar fasciopathy?
Patients report pain under the heel of their foot. Usually the pain is worse getting out of bed in the morning and loosens up with some exercise. Ultrasound is equivalent to MRI and can be used in the clinic with a physical exam to diagnose plantar fasciopathy.
What are treatment options for Plantar fasciopathy?
Nonsurgical options have included rest, activity modification, shockwave therapy, night braces, changing how you run from a hindfoot runner to a forefoot runner, orthotics, and heel cups.
Physical therapy should include massage of the calf muscles as this can help reduce tension on the plantar fascia. Strengthening should include foot intrinsic muscle strengthening which are very specific exercises to unload the plantar fascia.
If physical therapy does not improve your pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone can be injected into the bursa to decrease inflammation. The injection should not go through the bottom of the foot as this can reduce the cushion of the fat pad. The injection should be performed under ultrasound from the side of the foot.
Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP). Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function.
Other treatment options that can be helpful include Tenex. Learn more about tenex here.
If injections do not provide relief, the next procedure is to cut the tendon which is a last resort and has not shown to have positive long term outcomes.