Plantar fasciopathy: a current concepts review

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Cite this article: EFORT Open Rev 2018;3:485-493.

DOI: 10.1302/2058-5241.3.170080

Introduction

Plantar fasciopathy (PF) involves pain and structural changes at the proximal insertion of the plantar fascia in the os calcis. Thickening and degenerative tissue findings are more common than inflammatory changes, so the term ‘plantar fasciopathy’ should better define the disorder known as ‘plantar fasciitis’.

One in ten people will suffer from PF in their lifetime. Around 2 million people worldwide receive treatment every year for this condition.1 We attend around 500 cases of chronic PF in our foot and ankle unit each year, although most cases are possibly managed by primary healthcare practices and do not reach our clinic. Frequently, patients do not look for primary health advice until symptoms are already chronic. Most patients are not referred to the orthopaedic clinic until their symptoms are recalcitrant.

The peak incidence of PF occurs in persons aged between 45 and 65 years.1 Around 90% of patients with PF will find that their symptoms resolve within 12 months with conservative treatment.2 In the last 15 years, the focus of non-operative treatment has changed from orthoses and splints to different types of stretching routines. The focus of operative treatment has also changed from understanding the mechanical disturbance caused by plantar fasciotomy, to understanding pathomechanics with risk factors predisposing to PF. Thus, proximal plantar fasciotomy has also given way to gastrocnemius recession as the most common surgical procedure for recalcitrant PF.

The aim of this study was to critically evaluate literature investigating epidemiology, pathomechanics, and management of chronic PF. A search of PubMed, SPORTSDiscus, PEDro, Cochrane Database, CINHAL, and Web of Science was conducted using the search terms “plantar fasciitis”, “plantar fasciopathy”, “heel pain”, “fasciotomy”, and “gastrocnemius recession/release”. Our focus was on articles that provided information on epidemiology, pathomechanics and treatment of chronic PF. Systematic reviews and randomized controlled trials were studied as well as seminal papers that have introduced changes in treatment over the last 30 years.

This review aims to summarize the current literature with special attention to pathomechanics and recent changes in management of chronic PF.

 

Manuel Monteagudo

Pilar Martínez de Albornoz

Borja Gutierrez

José Tabuenca

Ignacio Álvarez

3.1700EOR0010.1302/2058-5241.3.170080