I have a basic understanding that chronic plantar "fasciosis" is a degenerative condition of the plantar fascia rather than an inflammatory condition with no histological signs of inflammation present...
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Bearing this in mind, what is the actual mechanism of pain in this condition? We all know that the heel pain associated with chronic plantar fasciosis can be very debilitating, but can anyone tell me what exactly the pain is caused by?
Is it inflammation of the surrounding structures/soft tissue?
Is it pain receptors in the plantar fascia itself?
Is it entrapment of the inferior calcaneal nerve?
Is it some form of vascularisation of the attached bone marrow or bone contusion or bone edema?
Thanks for any help with this one.
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I’m sure you probably already know this, but I think it would help if you first recognised the biomechanical properties of the plantar aponeurosis. The main role of the plantar fascia is to resist deformation of the medial and lateral longitudinal arches during weight bearing activities. Due to the continual tensile loading forces that are placed on this ligamentous structure, sometimes certain activities such as walking, running or sport, and/or certain biomechanical predispositions, may subject the plantar fascia to abnormal tensile loading forces. As a result, repetitive microtrauma occurs.
Apart from neurological involvement, I would suspect that the answers to most of your questions would be secondary to abnormal tensile loading forces to this structure. For example, some acute cases we see maybe inflammatory in nature, whilst others are more chronic in nature, but in my opinion, the mechanism of injury would be a result of abnormal tensile loading forces.
In addition, the only other exception to this would be to also take into consideration is that excessive compression loading forces can also cause this problem as well, such as basketball or other related jumping activities. Not only could this potentially cause proximal plantar fasciitis but also possibly a bone contusion as well.
I hope this helps.
Regards
Daniel -
Have you looked at this thread - Disorders of the Plantar fascia MRI pictorial Review
and read this ?
Plantar Fasciitis
A Degenerative Process (Fasciosis) Without Inflammatio -
thanks for the link, and the article - yes, I have read the article, but it doesn't mention anything about what actually is involved in creating the pain that is experienced in the heel of nearly all patients with plantar fasciitis/fasciosis.
Cheers,
Berms. -
I don't seem to follow what your asking. Are you specifically wanting more information regarding the pathophysiology of this condition?
In addition, I think some of your questions should actually be regarded as DDx rather than putting them under the umbrella of plantar fasciitis/fasciosis.
Regards
Daniel -
Thanks for the thread links, and now that I have read both articles they seem to contradict each other considerably or at least they seem to (I've had a few glasses of wine).
The first states that with the help of MR imaging, plantar fasciitis (both acute and chronic) display chronic inflammation of the aponeurosis and the perifascial structures as well as inflammation at the osseotendinous junction, as characterized by collagen degeneration and necrosis, angiofibroblastic hyperplasia, chonroid metaplasia and matrix calcification.
However, the second article argues that the histological changes are degenerative and not inflammatory in nature.... So now I'm more confused, is it an inflammatory condition or is it not??
Cheers,
Berms -
I am specifically asking, if the condition of plantar fasciitis/fasciosis is not an inflammatory one, then what exactly causes the pain? What is the pathophysiology by which pain is generated?
Thanks,
Berms. -
if there is blood there are white blood cells and possible inflammation, so it´s not just depended on inflammation cells in the fascia. - according to a patient who is a world leading researcher in inflammation responses of the body - mainly the lungs but I guess they know a bit. But the increased tension over longer periods causes the degeneration of the fascia -
I'm on the same page as you now. Obviously, true plantar fasciitis is probably inflammatory in nature which is the likely pathophysiological mechanism by which pain is generated.
As for plantar fasciosis, I am unsure as to what the exact mechanism would be as its considered to be degenerative. My own assumption would be that if continual tensile loads are transmitted through this ligamentous structure then plastic deformation may begin to occur which means the tissue will not be as healthy or function optimally anymore. Perhaps this may result in a continual stimulation to the nociceptiors. These are just my thoughts though...
Cheers
Daniel -
Thanks,
Berms. -
Thanks,
Berms -
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Do you think micro tearing of the fascia itself can cause perceivable pain? Are there pain receptors actually located in the fascia itself?
Cheers,
Berms. -
Good luck and if you find out let us know. :drinks -
Cheers,
Berms -
The rubber band explanation works very easily and patients understand. Talk about continual stimulation to the nociceptiors and the patients forgotten before they leave your office. -
I’m specifically referring to the deep somatic nociceptors which are found in ligaments, bones, tendons etc. These are responsible for deep pain not superficial pain as nociceptors are also found in the skin and other superficial structures. In the context of this discussion, I’d specifically be referring to the deep somatic receptors in the plantar aponeurosis - namely the central and medial components as these are the most common areas affected. As plantar fasciitis progresses from an acute to chronic problem then I’d speculate that possible plastic deformation is likely to occur in this structure which may possibly make the plantar aponeurosis less compliant, therefore increasing the potential for increased, prolonged abnormal tensile loading forces in this structure. As a result of the chronic tension, I feel that this may stimulate the deep somatic nociceptors, which I think could be responsible for the pain found in plantar fasciosis.
In my opinion, if we are specifically discussing true Plantar fasciosis, then the only anatomical structure of interest then should be the plantar aponeurosis/plantar fascia.
Regards
Daniel -
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I'm glad I could be of assistance. I should also thank you too as I hadn't put much thought into the subject until now.
Cheers
Daniel -
I can accept that there is no actual inflammatory changes in the fascia itself when considering the fasciitis vs "fasciosis" debate, but I knew from the symptoms patients experienced and the clinical presentation of the condition that there has to be more to it than that. That is what prompted me to start this thread and find out exactly what pathophysiology is occurring that causes these familiar symptoms and clinical presentation of pain and inflammation of the surrounding soft tissues.
Cheers,
Berms
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