You will see Plantar Fasciitis (PF) called many things! There is an open
debate about the term Plantar Fasciitis; it is argued that there isn’t
inflammation in chronic cases (therefore not an “itits”), however this is
yet to be confirmed.
What is happening on a celluar level is still under investigation, we are
learning more and more all the time, so therefore you see many
differently and interchangeable names (Plantar Fasciosis, Plantar
Fasciopathy, Plantar Heel Pain, Plantar Apotheitsis) for which is
essentially the same this. Pain in the heel!! We are sticking to the better
known “Plantar Fasciitis” in this text as it’s the better known term.
Plantar Fasciitis is characterised by degenerative changes at the plantar
fascia enthesis- where the plantar fascia connects to the heel bone.
It is thought the happen due to an imbalance in collagen production and
degradation, which causes disorganization in the structure. This
disorganized structure then becomes inefficient at absorbing shock. To
absorb shock you need long collagen fibers which align with the force that
the tissue is designed to take. If the tissue becomes disorganized then
those forces can not translate through the collagen fibers, it’s like pulling
on a hose pipe which crisscrosses across the garden and trying to get the
other end to move, compared to healthy tissues which would behave like
a tight tow rope.
On ultrasound, individuals with plantar fasciitis are 105 times more likely
to have a fascial thickness, this represents the degenerative changes;
and up to 50% have an inferior calcaneal spur and bone edema on the
heel is common. However these findings are not predictive of pain,
function and tissue integrity. Which makes diagnosis via scans alone
complicated!! Diagnosis is more based on a combination of symptoms
and a scan.