Plantar Fasciopathy (Plantar Fasciitis, Heel Spur)

Let’s use this topic to discuss plantar fasciopathy, or, as it’s more commonly, if erroneously known, plantar fasciitis. This is a topic that I’m all too familiar with, having suffered with it in my right foot for 18 months starting in fall 2012, and in my left foot again starting in December 2018 (still going on).

I’ll update this post with additional links and resources as I find them, but feel free to ask questions or comment below and I’ll do my best to answer or ask friends who know more than I do.

To kick things off, the best overall resource I’ve found is this online book, which is chock full of helpful discussions, links to research, and explanations of what’s going on. It’s $19.95, but there’s a lot available to read for free. The same author, who I know slightly, has books on other conditions as well.

It’s a little out of date now, but before I found the book above, this 2013 Running Writings post was my go-to recommendation.

Oh, and the reason it’s not “plantar fasciitis” is because the -itis suffix means it’s an inflammatory condition, but research shows that’s not true (which is why anti-inflammatory treatments don’t work). Instead, it’s a degenerative condition generically called a tendinopathy that affects the plantar fascia. Hence plantar fasciopathy.

Much like with IT Band Syndrome, for me personally I found that the most useful approach was manually stretching it out, in this case via one of those socks at night. But even during the day I could do things where I would sit in a position that would stretch out the bottom of the foot. Wrapping the arch was a temporary help, same with rolling over a ball and strength exercises.

The approach of manually forcing the extension of the fascia seems a bit medieval but makes sense from a biomechanical standpoint. However, I will say it doesn’t work for everyone, especially when the condition is pretty severe.

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I’ve tried the Strassburg Sock, but it really doesn’t work for me because it pulls too hard on my toes and causes pain, plus the strap gets caught on the covers at night. I always end up ripping it off at some point.

Instead, I have this night split from Darco that was given to me by a doctor during my 2012 bout of PF. It’s OK, but I don’t love it. The pneumatic part of it broke nearly instantly, and the velcro straps are a little too long so they don’t connect to themselves, but instead to the general covering.

If I were buying one of these now, I’d try this one, which looks a bit simpler and is cheaper:

I might also try one of these super cheap versions that goes over the front of the ankle. The risk is that its adjustable aluminum bar in the front will be uncomfortable—the 1-star reviews mostly mentioned that.

I bought one of those braces first actually, more like the second simpler splint rather than the first. I agree, it was okay, but it didn’t do all that much for me. I agree, the sock is extremely uncomfortable, and I definitely ripped it off at night most nights. But even having it on for however many hours I was asleep helped over time. I did notice that if I could even mimic that position with my foot and my blankets pressing down on the top of my foot helped a decent amount. When you lay on your stomach, your feet tend to be pointed away from you, which is exactly the position you don’t want them to be in.

Really, this is a pretty insidious injury, because a lot of other ones you can more easily access, or attack the muscles, or such. It’s also one where, at least for me, rest didn’t help since I’d just still feel the tightness day after day; as you said, it’s not particularly an inflammation.

The technical term for pointing your toes down, for those who care, is plantarflexion, and it’s the opposite of the dorsiflexion position where you bring your toes as close as possible to your shin (and stretch your calf muscles, which is good for PF).

You’re absolutely right about sleeping on your stomach. I’ve found that the trick, if you need to sleep on your stomach, if you’re tall enough, and if it works with your mattress, is to hang your feet off the edge of the bottom of the bed, so they can be dorsiflexed while you sleep. My mattress is good for this, since it doesn’t have a seam or rim on the corner; if it did, I’d try putting a folded towel under the bottom sheet to pad things out.

I knew there was a word for it and could not remember for the life of me. The only ones that came to mind were pronation and supination. Thanks!

To throw another broad scoping term in, we now lump almost all of these injuries into “plantar heel pain”

Interestingly, this one is also treated like a tendinopathy (see my ITBS post). The most promising research on it right now is a group out of Denmark looking at a loading protocol using a heel raise variation with the toe propped (forcing what’s called the “windlass mechanism”). A physio out of Australia created this EVA foam device to help with the logistics of the exercise:

(Disclosure: I am not getting paid by them, but I do find it helps speed things along with the setup of the exercise in the clinic).
Much like the ITBS etiology, it seems like an irritation/compression of the fat pad near the insertion of the plantar fascia is the “tissue” at fault, so loading the area as much as it can tolerate before flaring up seems to be the best option we have so far. This is still a long process (not uncommon to see cases last >2 years).
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Jason turned me on to this little gizmo a while back, and it’s possibly the best $30 I’ve spent. And yes, I have way too many gadgets that promise to help because when you’ve been suffering for many, many months, you’ll grasp at straws (which don’t help with PF either). None of the others have stuck for me, but I use this one regularly to help with the windlass effect while doing heel raises and drops.

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This seems like a pretty good video explaining the cause and what can help to fix plantar fascia pain

I had a frustrating ordeal with plantar fasciopathy starting about a month after I resumed running after having my daughter. Like many women, I found my feet had grown 1/2-1 size through pregnancy. I think that aside from taking time off, one of the factors that made the biggest improvement for me was doing all those silly little foot-strengthening exercises, like making arches and using my toes to bunch up towels. AND my feet went back to their original size (or close enough, anyhow).

Looks like there’s a link between estrogen levels and the plantar fascia that would help explain your experience.

Here’s a question, @JTuori. Does imaging (ultrasound, X-ray, MRI) offer much utility in diagnosing plantar heel pain from different causes, or does the treatment end up being the same anyway? With my first bout of PF, I was prescribed an MRI to distinguish between PF and a stress fracture, but the doctor later admitted afterward that the conservative treatment would have been the same either way.

Good question, the only time it would make much of a difference would be if it was a suspected stress fracture. That said, it’s pretty rare that a stress fracture in the calcaneus would be from running / the same etiology as a true plantar fasciiopathy. What I see a lot clinically is that people will get an X-ray that shows “calcification” or a “bone spur” then get concerned that it won’t get better with removing it- that is definitely not the case, as it becomes asymptomatic like the majority of the other calcific tendinopathies we see. MRI or ultrasounds don’t usually help to guide the treatment since we’ll end up doing the same progressive loading anyway, they just may rule out other insidious pathology.

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