Plantar heel pain (formerly known as plantar fasciitis): What even IS PHP?!?!

Plantar heel pain(PHP), previously known as plantar fasciitis or fasciopathy, was rebranded to plantar heel pain because the “itis” makes it seem like a short-lived inflammatory reaction - and, unfortunately, PHP is not short-lived in many cases :(

It can take a while (up to a year!!) to heal this condition, so don’t get down on yourself if you’ve been dealing with it for a while!

The PF’s Anatomy

Fascia is connective tissue - it’s a type of material with collagen that’s strong and supports your muscles, bones and organs.

The plantar fascia (PF) is that connective tissue that goes from your heel to the base of your toes.

It’s stressed when you are walking or running, when you put your foot in front of you and the majority of your weight is on that heel.

What characterizes PHP?

Like ALL injuries, the PF may become spicy & painful when its capacity to handle stress is outweighed by the stressors placed upon it (like if you go from 0 to 5 days of running per week with limited ramp-up time.)

Usually people with PHP will describe pain when they get out of bed and take their first steps in the morning, and they have tenderness to the bottom of their foot or heel.

(This is most likely because when you sleep, your feet are in a position of plantarflexion, so it’s kind of a shock to them when they have to immediately stretch in the opposite direction when you put your feet on the ground!)

But what reallllly causes it?

There have been a few risk factors associated with PF. (1)

1. Sedentary lifestyle.

2. Decreased dorsiflexion mobility, which is the ability to move your foot toward your face using your ankle joint.

3. Sudden weight gain.

4. BMI over 30.

5. Increased time spent on your feet day to day.

6. Overuse, such as with running, walking or standing for work, without a gradual build up period.

It may seem counterintuitive that both sedentary lifestyle AND overuse can lead to this condition, but such is the world of injuries! Pain actually tends to be more severe in sedentary folks- so there’s a plug for exercise! (2)

Just having one or more of the risk factors listed above should not make you panic! Risk factors are associations we’ve made with an injury, but don’t mean you’re guaranteed to have the condition. They can serve as a loose guideline for what we might start working on if you come to me with PHP.

Some of the low-hanging fruit for managing PHP pain are:

1. Decreasing your running intensity and volume

2. Potentially using an orthotic

3. Maybe giving yourself a little foot massage for immediate pain relief (this works for some folks and inflames it for others, and hasn’t been shown to help relief long term)

The biggest factors involved in healing PHP are

1. Managing running load.

2. Performing active foot and calf strengthening & lengthening.

We’ll dive deeper into how to treat PHP next week!

Just know that if you’re frustrated with this or any injury, you can 100% get back to doing the things you love - it may just require a different approach than you’re used to.