10. Plantar Heel Pain (Plantar Fasciopathy)

Plantar FasciopathyHosts: Dr. Teddy Bross & Dr. Roger MatthewsEpisode Summary: In this episode of Highpoints, Dr. Roger Matthews and Dr. Teddy Bross discuss plantar heel pain, now more accurately termed plantar fasciopathy, and explain why the older term “plantar fasciitis” is misleading. They review the key anatomy and biomechanics of the plantar fascia, including its role in supporting the foot arch and the windlass mechanism that tensions the tissue during toe-off. Classic symptoms such as sharp first-step morning pain, worsening with load, and partial improvement with activity are emphasized, along with common risk factors like increased running volume, prolonged standing on hard surfaces, and limited ankle dorsiflexion. Diagnosis is primarily clinical, supported by ultrasound measurement of fascia thickening, while heel spurs on X-ray are noted to be poorly correlated with pain.Treatment is centered on progressive loading through stretching and strengthening of the plantar fascia and surrounding musculature, load management, and gait modification, with adjuncts such as orthotics for temporary relief. For persistent cases, shockwave therapy and platelet-rich plasma injections are discussed as evidence-supported options, while corticosteroid injections are used more cautiously due to rupture risk. Surgery is reserved for refractory cases. Overall, the episode emphasizes that successful recovery depends on consistent, active rehabilitation rather than passive treatments, with most patients improving over time when appropriately managed.Corrections and Clarifications:1. Heel spur correlation — overstated as "no correlation": "heel spurs do not reliably predict or cause plantar heel pain" rather than stating there is zero correlation.2. Steroid injection "lifespan" described as "about three months": The Cochrane review found that corticosteroid injection benefits over placebo were present only up to 1 month, with no significant difference after 1–6 months.