Thanks for taking the time to sit down and answer some questions Hamish!
Among a few other areas, you have a strong clinical interest in treating what is most commonly known as plantar fasciitis; can you give our readership an overview of what plantar fasciitis is, how it typically onsets and how it behaves?
The plantar fascia is a band of fibrous tissue that travels from the heel to the forefoot. To keep things simple during a period of plantar fasciitis the plantar fascia becomes sensitive to pressure and load (the underlying mechanism are still not completely understood). It affects around 7-10% of the population with even higher rates is certain populations such as runners.
We typically see a gradual or sudden increase in pain under the heel or arch of the foot. Although it is a personal experience most people will describe higher pain levels with first steps after rising in the morning and or with prolonged time on feet such as walking. Its severity can vary from affecting activities of daily living to discomfort with high loads such as long distance running.
Is there are common age group that it mostly affects, and if so, any particular reasons why it affects this demographic?
We most commonly see plantar fasciitis in middle aged people. Although not totally understood potential reasons for this may be due to increased BMI, the loss of the tissues elasticity as we age as well as its decreased ability to tolerate acute and chronic changes in tensile loading.
Like most things in the medical world, as time evolves, conditions get given new names. Plantar Fasciitis is no different; what is it now referred to and why?
Plantar fascitis, plantar fasciosis, plantar fasciopathy or plantar heel pain? The name has changed as we learn more about the pathophysiology of the condition. We now generally refer to it as plantar fasciopathy or plantar heel pain. Plantar Fasciitis was based on the fascia being inflamed ‘itis’ however we know this is generally not the case. Interestingly, findings on imaging such as inflammation, tears, bone spurs and plantar fascia thickening are not always the reason for the pain with these ‘abnormalities’ often seen in the feet of pain free people as well.
Unfortunately these image findings can at times have a negative or nocebic affect on people, leading to the association of pain with tissue damage, and subsequent fear avoidance behaviours around using the foot.
Does plantar heel pain need imaging to confirm the diagnosis, or is a diagnosis made by clinical presentation?
Plantar heel pain can generally be diagnosed by clinical presentation through a detailed subjective and objective assessment. Although rare further diagnostics maybe at times required to rule out other sinister pathology masquerading as plantar heel pain.
I commonly see plantar heel pain present after the patient has had worsening symptoms over 2-3 months; do you see plantar heel pain present acutely? And if so, how would your management differ between a sudden acute presentation compared to a chronic presentation?
I actually just followed up an acute bout of plantar heel pain a few hours ago. I saw her last week after she suddenly developed arch/heel pain after introducing a speed session to her regular runs (an sudden spike in unaccustomed load). My initial plan and treatment advice was to deload the sensitive tissue so we discussed load management strategies and used a taping technique.
If she’d been experiencing this pain for a number of months then my aim would be to improve tissue load tolerance by progressively loading her plantar fascia tissue up through specific exercises.