Management for the Plantar Fasciopathy

Yinghui Jia

First Clinical Medical School, Shanxi Medical University, Shanxi, 030000, China

Keywords: Plantar Fasciopathy, Conservative Treatment, Pain Management.

Abstract: Plantar fasciopathy (PF) is a degenerative condition with the preference of pain or discomfort at the base of

the foot. This article summarizes the advances of treatments and condenses the cause, diagnosis and

prevention of PF, aiming to provide a basis in managing PF. Causes of PF includes insufficient ankle

dorsiflexion, increasing age, thickening in plantar fascia, high body mass index (BMI) and long-term weight

loading or overexercise. Diagnosis is history and physical examination of a history of pain or discomfort in

the heel that had been particularly severe during the first morning steps after rising, with tingling on palpation

of the heel. And the performance of thickening of plantar fascia on Ultrasound can be used to confirm.

Treatments include physical therapy (PT), extracorporeal shock wave therapy (ESWT), platelet-rich plasma

(PRP) and acupuncture. Every treatment has different characteristics and the efficacy varies from person to

person.

1 INTRODUCTION

Plantar Fasciopathy (PF) is a degenerative condition

that result from biomechanical overuse, including

fasciitis (acute inflammatory) and fasciosis (chronic

degenerative diseases). PF typically manifests as pain

or discomfort in the calcaneus, the base of the foot

where the metatarsal fascia inserts and is frequently

worst during the first few steps after waking up in the

morning (Tan et al., 2024). A third of PF is bilateral,

although the majority is unilateral (Tseng et al.,

2023). The incidence of PF is 4‰ per year and the

lifetime incidence is amost 10%, which indicates that

PF occurs in about 10% of the population in their

lifetime. The ankle dorsiflexion limitation is the main

risk factor (Tseng et al., 2023).

PF brings a negative impact on people’s life

satisfaction and athletic experience and can even have

physical and psychological repercussions. Currently,

there has been a substantial increase in the number of

publications on PF, which indicates that the emphasis

on PF has been increased in recent years.

At present, diagnosis of PF has been relatively

clear. Currently PF is generally diagnosed by history

and physical examination (Tan et al., 2024).

Ultrasound is also an acceptable diagnostic method

for PF. As for conservative treatment, physical

therapy (PT) and extracorporeal shock wave therapy

(ESWT) have emerged as the mainstream treatment

methods. Acupuncture and platelet-rich plasma

(PRP) have also gained popularity in recent years.

And for patients who fail to nonoperative therapy and

the pain became chronic, surgery is generally

performed. Only conservation treatments are

described in this article. PT is a safe, convenient and

effective treatment dealing with PF, but its efficacy

varies in individuals. ESWT is a noninvasive and

highly effective modality with a short course of

treatment, while is not suitable for bleeding or

infected individuals. PRP is a treatment with good

long-term effect, but the cost is high. Acupuncture

offers pain relief and improves circulation, but has

poor medical compliance. However, none of these

treatments are the best. The efficacy depends on age,

BMI and the severity. Prevention of occurrence and

recurrence of PF is a good way to improve the quality

of life for patients. These days, more and more studies

have focused on treatment options for PF, but there is

a lack of systematic sorting and analysis. This article

provided a summary of the disease's cause, diagnosis,

therapy, and prevention with the aim of giving most

patients a basis in managing their PF.

2 CAUSE OF DISEASE

PF is a degenerative condition and is a collective term

for heel pain caused by acute inflammation and

chronic degenerative disease in the heel. Causes of PF

are multifactorial, including range of ankle

380

Jia, Y.

Management for the Plantar Fasciopathy.

DOI: 10.5220/0014493700004933

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Biomedical Engineering and Food Science (BEFS 2025), pages 380-384

ISBN: 978-989-758-789-4

dorsiflexion, age, plantar fascia thickness, body mass

index (BMI) and long-term weight loading or

overexercise. Among them, ankle dorsiflexion

limitation is the main risk factor (Tseng et al., 2023).

The incidence increased significantly between 40 and

60 years of age, and the incidence rates of PF among

adults by age were as follows: Between the age of 30

and 40 (22%), 41 and 50 (36%), 51 and 60 (32%), 61

and 70 (2%), and over 70 (8%) (L et al., 2013). The

plantar fascia thickness of PF patients was 2.16mm

lower in comparison to that of normal individuals

(95% CI:1.60~2.71 mm, P<0.001), which became

one of the criteria for the diagnosis of PF (X et al.,

2021). Individuals who were overweight with

BMI>25kg/m² or obese with BMI>30kg/m², were 1.4

times more likely to have PF than others. Occupation-

related prolonged weight-loading and overexercise

also increases the likelihood of PF, which may be

related to the prolonged elevated plantar load. In non-

athletic population, factors associated with plantar

heel pain also include specific foot such as foot with

collapsed arch, and insufficient ankle strength

(Sullivan et al., 2020). Moreover, psychological

factors encompass depression, nervous,

kinesiophobia and catastrophizing are also associated

with PF (Mørk et al., 2024).

3 DIAGNOSIS

Consensus statements and guideline for the diagnosis

and management of plantar fasciitis in Singapore’

pointed out that history and clinical evaluation to

diagnose PF is a common method that had reached

general consensus (Tan et al., 2024). Common

symptoms of PF include plantar heel pain or

discomfort, which is exacerbated during the first few

steps after waking up or after a period of inactivity.

While adequate activity helps lessen pain, excessive

activity or weight-bearing tasks will cause it to return.

Physical examination is generally characterized by

the following two points. First, patient may walk in

an abnormal posture to minimize heel pain. Second,

palpation of the medial side of the calcaneal triggers

tingling (Goff and Crawford, 2011).

It is worth noticing that other causes of heel pain

should be ruled out before a diagnosis of PF is made,

including calcaneal spur, plantar tendon injuries, and

scaphoid fractures. Beside Ultrasound (US) is a

reliable way to differentiate, and is a common option

in not only diagnosis, but also monitor due to its low

prices and convenience. Ultrasound of PF showed

thickening and hypoechoic of the plantar fascia,

which is one of the criteria for auxiliary diagnosis.

Moreover, radiographic imaging and Magnetic

resonance imaging (MRI) are valuable ways to view

tendon and bone lesions, but they are incompletely

necessary when symptoms are clear. MRI shows an

increase in plantar fascia and a signal increase on T2-

weighted and short tau inversion recovery images.

4 TREATMENT

4.1 Physical Therapy (PT)

PT, a first-line treatment, mainly includes stretching

and strengthening. Both can reduce pain and correct

gait pattern and show good results. In a randomized

controlled trial involving 50 patients, the control

group (n=25) received ankle mobilization training,

and the intervention group (n=25) received the same

combined with gluteal muscle strength training (X et

al., 2024). For four weeks, both groups received

training twice a week and they were monitored for 3

months following therapy. The American Orthopedic

Foot and Ankle Society (AOFAS) and Visual

Analogue Pain Score (VAS) were utilized for scoring.

According to the result, the intervention group had

lower VAS (1.52 vs 2.68, P<0.01) and higher AOFAS

ankle-hindfoot scale (89.64 vs 81.24, P<0.01), from

which it can be inferred that ankle mobilization

combined with gluteal muscle strength training

significantly improved functional results and

decreased heel pain in patients with PF.

In another research, which involves 56 patients

also shows a positive result (H et al., 2024). In this

research, patients were split into two groups at

random: an observation group and a control group,

each with 28 patients. Both groups received

stretching instruction, and kinesio taping was added

to the observation group. After the treatment, the

outcome in the observation group was manifested by

a lower VAS (3.85 vs 3.03, P<0.05), a higher AOFAS

(56.35 vs 62.13, P<0.05) and a higher Berg Balance

Scale (BBS) (34.22 vs 37.79, P<0.05). It is to say,

stretching training plus kinesio taping can reduce

pain, improve joint movement, and enhance balance

ability in patients with PF.

PT can be combined with other mechanical

treatment, encompass night splints, rock shoes, and

ankle-foot orthoses. Moreover, PT can also be

combined with injection as aids. In general, PT is

used as the first choice of treatment, and other

therapies are selected after PT is ineffective.

Management for the Plantar Fasciopathy

381

4.2 Extracorporeal Shock Wave

Therapy (ESWT)

As a recent research hotpot and a noninvasive

treatment, ESWT is usually used to treat fasciopathy.

The mechanism of action of ESWT is to produce

minor-injury in the fascia, which promote

regeneration of capillaries and fibers (Majidi et al.,

2024). Clinical studies with 86 PF patients assigned

at random to either the observation group (ESWT

plus CSI treatment) or the control group (CSI

treatment) showed that the observation group had a

lower Simplified McGill Pain Questionnaire score at

one month (14.50 vs. 17.59, P<0.05) and three

months (9.68 vs. 11.97, P<0.05); a higher AOSAF

(84.33 vs. 79.01, P<0.05; 89.85 vs. 84.36, P<0.05);

lower foot pressure (6.71 vs. 8.26, P<0.05; 4.62 vs.

7.32, P<0.05); and a higher overall effective rate

(95.35% vs. 79.07%, P<0.05). This indicates that CSI

combined with ESWT has a better result than CSI

alone (N et al., 2024). 160 patients were randomly

assigned to 4 groups (n=40) in a randomized

controlled experiment, and each group was treated

with varying frequencies of ESWT: 1Hz for group A,

5Hz for group B, 10Hz for group C and 15 Hz for

group D (J et al., 2021). Following treatment, group

B had the lowest dynamic plantar pressure (A17.31,

B9.82, C11.89, D17.51, P<0.05), along with

significantly higher stride lengths (A32.875,

B40.800, C33.022, D30.089, P<0.05), support phases

(A56.22, B64.64, C61.17, D58.53, P<0.05), and

swing phases (A43.78, B35.36, C38.83, D41.47,

P<0.05) than the other three groups. This experiment

indicates that ESWT at different frequencies showed

positive effects in improving plantar pressure and

gait, and the treatment frequency of 5hz was the best

for ESWL treatment.

4.3 Platelet-Rich Plasma (PRP)

By injecting the patient's own blood plasma with a

high concentration of platelets into the treatment site,

platelet-rich plasma (PRP) is a promising therapeutic

approach. Through lowering inflammation and

promoting stem cell activation, PRP helps to heal

tendons and ligaments (Zhang et al., 2025).

Furthermore, PRP can improve joint range of motion,

muscle strength and gait. In a randomized clinical

trial, 90 patients suffered from PF with failed

conservation treatment were enrolled and were

randomly divided into 2 groups(n=45) (Sharma et al.,

2023). The two groups were separately treated with

steroid injection (steroid group) and PRP (PRP

group). The patients had evaluations at the third and

sixth months and were monitored for six months.

AOFAS and VAS were chosen as the evaluation

criteria. The result was, compared with the steroid

group, the PRP group has higher VAS score (4.22 vs

3.14, P<0.001) and lower AOFAS score (63.80 vs

75.76, P<0.001) at the third month, but at the sixth

month, the PRP group has lower VAS score (1.97 vs

2.71, P<0.05), higher AOFAS score (86.04 vs 81.23,

P<0.05) and lower plantar fascia thickness (3.53 vs

4.58, P<0.001). This trail indicates that the short-term

efficacy of PRP was not as good as that of steroid

injection, but the long-term efficacy was significantly

better.

Since the patient's own blood is used to make

PRP, it has little side effects and doesn't induce an

immunological reaction. Although PRP shows great

promise, more clinical study is still needed to

determine its precise mode of action and whether

there are any possible hazards.

4.4 Acupuncture

Acupuncture is a traditional Chinese medicine

treatment that encompasses a variety of therapeutic

techniques involving different types on needles. This

paper only elaborates on this broad category and does

not make a detailed division. Acupuncture effectively

reduces pain in PF in the short term efficacy

[SMD=1.40, 95%CI(0.63, 2.17), P<0.05], medium

term efficacy [SMD=1.07, 95%CI(0.27, 1.87),

P<0.05], and long term efficacy [SMD=1.41,

95%CI(0.74, 2.09), P<0.05], according to a meta-

analysis of 19 studies that used standardized mean

differences (SMD), 95% confidence intervals (CI),

and VAS for data analysis and scoring(W et al.,

2024). The short-term effect of acupuncture is not

obvious in improving the function of foot and ankle,

but the medium [SMD=0.61, 95%CI(0.14, 1.09),

P<0.05] and long-term [SMD=1.75， 95%CI(1.28,

2.22), P<0.05] effect is better. Moreover, acupuncture

can also reduce the thickness of plantar fascia

[SMD=1.41, 95%CI (0.51, 2.31), P<0.05]. A separate

meta-analysis which selected 32 studies with a total

2390 samples similarly demonstrated the pain

reduction of acupuncture compared to placebo

treatment [mean difference (MD)=-1.33, 95%CI (-

2.19, -0.46)] (Asokumaran et al., 2024). This analysis

suggests that acupuncture should be as a second-line

therapy for PF together with other treatments

including ESWT and PRP. The small needle-knife

treatment is comparable to ESWT in terms of short-

term pain relief [MD=2.20, 95%CI(-2.77, 7.16),

p=0.39] and healing [odds ratio(OR)=1.87,

95%CI(0.80, 4.37), p=0.15], but may be better than

BEFS 2025 - International Conference on Biomedical Engineering and Food Science

382

ESWT in medium-term pain relief [MD=9.11,

95%CI(5.08, 13.15), p<0.00001] and long-term

[MD=10.71, 95%CI(2.18, 19.25), p<0.00001],

according to another meta-analysis comparing the

two methods for treating PF(Feng et al., 2024).

However, acupuncture has certain shorts. The

therapist should have sufficient treatment experience

in treating with PF and the medical compliance of it

is relatively low. Furthermore, the long-term

outcomes still need further research.

5 PREVENTION

Firstly, stretching after exercises is a good way to

avoid dorsiflexion limitation of ankle, which

decreased the main risk factor of PF. Secondly, in

order to improve ankle stability and arch support, it is

important to train the Buttock muscles, Lower leg

muscles and plantar muscle group. But it is important

noticing that overtraining or standing for long period

of time should be avoid. Moreover, gait pattern

should be emphasized in daily life. Gait assessment

can be performed and a professional therapist sought

for gait correction. Weight management and

supportive footwear with adequate cushioning can

also be chosen to release plantar fascia pressure.

6 CONCLUSION

This article summarized the cause, diagnosis,

treatment and prevention of PF. There are many

causes of PF encompass range of ankle dorsiflexion,

age, plantar fascia thickness, body mass index (BMI)

and long-term weight. For diagnosis, history, clinical

evaluation and US can make the diagnosis

conveniently and quickly. In daily life, patients can

also self-test by symptoms and physical examination.

In the terms of treatment, PT, ESWT, PRP and

acupuncture have their own characteristics, and all of

these treatments can reduce the VAS and improve

AOFAS. PT is widely used treatment with highly

safety. It is easy for patients to adhere it for a long

time and can obtain good long-term curative effect.

ESWT is an effective method in promoting fascia

regeneration and reduce adhesion, thus can quickly

relieve pain and improve gait. PRP is a promising

method with good efficacy in lower plantar fascia, but

has a higher price due to its tedious and high

demanding preparation. Acupuncture, as a traditional

Chinese medicine treatment, is totally worth trying

because of its good pain relief in the medium and long

term. However, its medical compliance is poor and

requires long-term adherence. Each treatment method

needs to be selected according to the actual situation

and personal wishes of patients. As for prevention,

patients should be aware of possible symptoms at all

times in their daily life. Measures such as stretching,

strengthening, and weight management should be

incorporated into everyday life. This article fills the

gap of the lack in systematic combing and analysis of

the treatment of PF, provide a reference in managing

PF for the majority of the patients and can also

facilitate other researchers to expand their

understanding of PF. In the future, more in-depth

studies on the treatment of PF need to be carried out,

and a more detailed criterion for the selection of

treatment methods for PF should be specified in order

to obtain the optimal treatment regimen.

REFERENCES

Asokumaran, I., Verasamy, B. S., Hasan, M. I. B., Wong,

D. K. C., Ong, S. S., & Ng, S. C. 2024. Comparative

Effectiveness of Acupuncture Versus Non-surgical

Modalities for Treating Plantar Fasciitis: A Network

Meta-Analysis. Cureus 16(9): e68959.

Feng, C., Yao, J., Xie, Y., Zhao, M., Hu, Y., Hu, Z., Li, R.,

Wu, H., Ge, Y., Yang, F. & Fan, X. 2024. Small needle-

knife versus extracorporeal shock wave therapy for the

treatment of plantar fasciitis: A systematic review and

meta-analysis. Heliyon 10: e24229

Goff, J. D., & Crawford, R. 2011. Diagnosis and treatment

of plantar fasciitis. American family physician 84(6):

676–682.

Han, X., Zhang, S., Zhang, G., Zhang, Z., Bao, S. & Wang,

C. 2024. An analysis of the efficacy of ankle joint

loosening combined with gluteal muscle strength

training in the treatment of chronic plantar fasciitis.

Chinese Journal of Rehabilitation Medicine (39): 1804-

1809.

Li, N., Wang, H., Lv, X., Wang, H. & S Qie, S. 2024. Effect

of extracorporeal shock wave combined with

corticosteroid injection in the treatment of plantar

fasciitis. Central South Medical Science Journal (52):

570-573.

Liu, X., Zhang, L., Zhang, H., Gan, X., Xiong, Y. & Li, M.

2021. Research progress of risk factors associated with

plantar fasciitis. Journal of PLA Medical College (42):

1124-1129.

Majidi, L., Khateri, S., Nikbakht, N., Moradi, Y., & Nikoo,

M. R. 2024. The effect of extracorporeal shock-wave

therapy on pain in patients with various tendinopathies:

a systematic review and meta-analysis of randomized

control trials. BMC sports science, medicine &

rehabilitation 16(1): 93.

Mørk, M., Soberg, H. L., Heide, M., Hoksrud, A. F.,

Groven, K. S., Brunborg, C., & Røe, C. 2024.

Predictors for pain and functioning in patients with

Management for the Plantar Fasciopathy

383

plantar fasciopathy one year after inclusion in a

treatment trial in specialist care. BMC musculoskeletal

disorders 25(1): 1049.

Sharma, R., Chaudhary, N. K., Karki, M., Sunuwar, D. R.,

Singh, D. R., Pradhan, P. M. S., Gyawali, P., Duwal

Shrestha, S. K., & Bhandari, K. K. 2023. Effect of

platelet-rich plasma versus steroid injection in plantar

fasciitis: a randomized clinical trial. BMC

musculoskeletal disorders 24(1): 172.

Sullivan, J., Pappas, E., & Burns, J. 2020. Role of

mechanical factors in the clinical presentation of plantar

heel pain: Implications for management. Foot

(Edinburgh, Scotland) (42): 101636.

Tan, V. A. K., Tan, C. C., Yeo, N. E. M., Zhang, M., Mehta,

K. V., Tian, R. H. H., & Tan, B. 2024. Consensus

statements and guideline for the diagnosis and

management of plantar fasciitis in Singapore. Annals of

the Academy of Medicine, Singapore 53(2): 101–112.

Tseng, W. C., Chen, Y. C., Lee, T. M., & Chen, W. S. 2023.

Plantar Fasciitis: An Updated Review. Journal of

medical ultrasound 31(4): 268–274.

Wang, J., Zhang, P., Wang, Y. & Liu, Z. 2021. Gait analysis

of extracorporeal shock wave therapy using different

frequencies for plantar fasciitis. Medical Innovation in

China (18): 14-18.

Wei, W., Liu, J., Zhang, Y. & Zhang, Z. 2024. Effect of

acupuncture on plantar fasciitis pain intensity and foot

dysfunction Meta-analysis. Chinese Journal of

Traditional Chinese Medicine Library and Information

(48): 232-237.

Wu, H., Feng, J., Zheng, X. & Long, D. 2024. The clinical

effect of stretching training combined with

intramuscular patch in the treatment of plantar fasciitis.

Reflexology and Rehabilitation Medicine (5): 58-

60+80.

Zhang, L., Ding, P. & Tang, P. 2013. Basic and clinical

research progress of plantar fasciitis. Journal of Hainan

Medical University 19(3): 429-432

Zhang, Z., Liu, P., Xue, X., Zhang, Z., Wang, L., Jiang, Y.,

Zhang, C., Zhou, H., Lv, S., Shen, W., Yang, S., &

Wang, F. 2025. The role of platelet-rich plasma in

biomedicine: A comprehensive overview. iScience

28(2): 111705.

BEFS 2025 - International Conference on Biomedical Engineering and Food Science

384