PRACTITIONER VOICE
Time for a rebrand - Plantar Fasciitis or Heel Pain ?
Riccardo Galeotti | BSc . Acupuncture
Abstract
Plantar heel pain ( PHP ), once humorously referred to as ‘ Gonorrhoeal Heel ’, has been confusing and frustrating people for centuries . While we ’ ve grown accustomed to the modern day term ‘ plantar fasciitis ’, it may be time for a rebrand . This article takes a humorous but evidence-based walk thought the diagnostic approaches , risk factors , and treatment options for this all too common condition . Exploring fascia with the current shocking revelation that it might be more than tendon breakdown than inflamed fiasco , we explore the ins and outs of this perplexing condition .
Plantar Heel Pain ( PHP ) has gone through quite the identity crisis over the centuries . Back in the 1600s , it was charmingly referred to as “ Gonorrhoeal Heel ”( 1 )( yikes !), clearly before anyone had Google to set the record straight . Fast forward a few hundred years , and it ’ s had all sorts of nicknames – “ Runner ’ s Heel ,” “ plantar fasciopathy ,” and the classic “ heel spur ”– none of which make it sound any more like fun . But the term that ’ s stuck around like a bad heel ache is “ plantar fasciitis .”
However , more recent wisdom suggests we should start calling it “ Plantar Heel Pain ” ( PHP )( 2 ) instead . Why ? Because not every case involves fascial inflammation ,( 3 ) and let ’ s be real , “ fasciitis ” makes it sound a lot scarier than it is . So , PHP it is ! You know , just to keep things broad and inclusive .
Diagnostic approaches and current guidelines
According to Buchanan ,( 4 ) PHP effects 10 % of the population at some stage in their lives and accounts for 11 % to 15 % of all foot symptoms in general practice . PHP is related to a tendon pathology , as it requires warming up to improve the overall pain and thus rest and immobility , particularly office work with constant reduction in load , will stir up the PHP . That is the biggest give away to PHP - that sharp pain when you first step out of bed in the morning , which eases after a few steps . The story is true for prolonged sitting or standing , again its either under-load or over-capacity that gets the PHP worked up ; and remember that tendons are 24-hour reminders of activity overload . Pain won ’ t necessarily increase immediately , but up to 24 hours after any increased load .
Diagnosing PHP is a bit like solving a foot-based mystery . It ’ s mostly about piecing together clues : where ’ s the pain ? What hurts when you poke it ? ( Yes , that ’ s an actual diagnostic tool ). In fact , 9 out of 10 times , poking around the plantar fascia ’ s proximal insertion point gives you all the answers you need and can provide critical diagnostic clues .( 5,6 ) But if you ’ re feeling fancy , you can break out the ultrasound machine – because , apparently , people with PHP are 105 times more likely to have plantar fascia thickening than their lucky , pain-free counterparts .( 5 ) Oh , and don ’ t forget to check off the five clinical guideline boxes : the lift-your-toes-in-dorsiflexion test ( aka the windlass test ( 7 ) – no , it ’ s not a magic spell ), a negative tarsal tunnel test ,( 8 ) limited ankle motion ,( 9 ) and the handy foot posture index checking abnormal foot posture ( 10 ) among others . Heel spurs may or may not be involved with PHP , but honestly , they ’ re like that guest at a party who doesn ’ t really belong - most people with them aren ’ t even in pain , or don ’ t even know they have the spurs , which suggests no link between the two . ( 6 )
Recent research on PHP
And here ’ s a plot twist for you : PHP might not even be the inflammatory beast we once thought it was . In fact , it ’ s starting to look a lot like tendinopathy – a degenerative condition where your tissues just give up a little ( 3 , 11 ) due to a change in load . So , all those anti-inflammatory meds might not even be the star of the show anymore . New research is pointing us toward a degenerative process , where the tissue starts breaking down without a ton of inflammation , so maybe hold off on those corticosteroid shots unless you ’ re really sure they ’ re needed .( 12 ) Who knew ? Another recent study also found signs of inflammation alongside degenerative changes , indicating that inflammation may still play a role in the deterioration of plantar fascia fibres .( 13 )
JATMS | Autumn 2025 | 29