Plantar Fasciopathy, commonly known as Plantar Fasciitis or Policeman’s heel, plantar fasciosis, or plantar heel pain syndrome, is characterised by pain and structural changes at the insertion of the plantar fascia to the calcaneus, a bone that forms part of the heel. Plantar fasciitis most commonly affects individuals aged between 45 and 65 years (Riddle & Schappert, 2004), with 2–4 cases per 1,000 people per year experiencing some degree of plantar heel pain (Rasenberg et al., 2019).
Plantar fasciitis is often misunderstood, and for those suffering from it, the condition can at times be incredibly debilitating. However, with appropriate therapy and guidance, 90–95% of cases resolve within 12 months (Crawford et al., 2003). For cases where symptoms persist beyond a year, reasons can vary from misdiagnosis to the presence of bony changes or gastrocnemius involvement.
Cause
Plantar fasciitis is generally considered to result from degeneration/soft tissue damage of the plantar fascia, leading to repetitive microtears in the fibrous collagen structure on the underside of the foot. This structure provides support for the arch, enables foot function, and protects vital anatomical elements. Contrary to common misconceptions, plantar fasciitis leads to inflammation rather than being caused by it.
There are several reasons why individuals may develop plantar fasciitis, with the most common being previous lower limb injuries, overuse (particularly in runners and military personnel), and excessive loading (such as being overweight or engaging in frequent heavy lifting). Due to the complexity of the human body, increased Achilles Tendon tension can lead to stiffness when pointing or flexing the toes, subsequently placing greater pressure on the plantar fascia.
Risk Factors
Plantar fasciitis is more prevalent in individuals over the age of 45, with those classified as obese experiencing a 1.4 times higher risk of developing the condition. Although it may be expected that Plantar fasciitis would affect both feet equally, only 1 in 3 patients present with bilateral symptoms (Neufeld & Cerrato, 2008), meaning that it is 66.6% more likely to occur in just one foot.
Sports involving heavy foot strikes, such as running, Irish dance, and kickboxing, increase the risk of injury to the plantar fascia, subsequently increasing the likelihood of developing plantar fasciopathy. Occupations that require prolonged standing, such as hairdressing, security, and nightclub bouncing, also pose a risk—particularly for individuals who are overweight.
A podiatrist may assess various factors, including gastrocnemius muscle function, foot posture, big toe movement, ankle mobility, leg length, and footwear, as well as taking a detailed medical history. In some cases, diagnostic imaging, such as X-rays, ultrasounds, or MRIs, may be required depending on symptom severity and frequency.
Treatments
Once diagnosed with plantar fasciitis, several treatment options may be recommended:
- Ice therapy – Rolling a frozen bottle of water under the foot while seated can help manage pain and inflammation.
- Non-steroidal anti-inflammatory drugs (NSAIDs)– Medications such as ibuprofen may be suggested to help control inflammation.
- Physical therapy – Strength-building exercises can improve acute symptoms and prevent recurrence. It is advisable to consult a professional to receive tailored exercises, although regular appointments may not always be necessary. Those lacking access to in-person care may consider online services such as www.kindmoves.co.uk, which have gained popularity during COVID-19 and continue to provide structured support led by physiotherapists or personal trainers.
- Orthotics – Individuals who spend prolonged periods standing may benefit from orthotics aimed at improving foot posture, improving foot function and reducing pressure on the plantar fascia insertion.
Sometimes, professionals offer novel solutions such as dry cupping, shock wave therapy, low-level laser therapy, and various other treatments that lack reliable evidence of providing any clinically significant benefit. However, these treatments can be a lucrative source of revenue due to their low delivery cost and premium pricing, often justified by the scientific theatre accompanying them.
At Caledonia Foot Clinic, we will always perform a detailed assessment and provide the best advice and treatment, following up-to-date evidence based practice and if you ever want a second opinion we encourage you to do so and will provide you with our notes to ensure the best outcome, with us, be confident in your care.
Book an appointment at www.caledoniafootclinic.com
Bibliography
Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004 May;25(5):303-10. doi: 10.1177/107110070402500505. PMID: 15134610.
Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008 Jun;16(6):338-46. doi: 10.5435/00124635-200806000-00006. PMID: 18524985.
Rasenberg, N., Bierma-Zeinstra, S.M.A., Bindels, P.J., van der Lei, J., & van Middelkoop, M. (2019) Incidence, prevalence, and management of plantar heel pain: a retrospective cohort study in Dutch primary care. British Journal of General Practice, 69(688), e801-e808. Available at: https://bjgp.org/content/69/688/e801 [Accessed 16 May 2025].
Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416. doi: 10.1002/14651858.CD000416. Update in: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD000416. doi: 10.1002/14651858.CD000416.pub2. PMID: 12917892.