Introduction

The correct terminology for foot conditions is a hot topic in professional circles where people care about providing the highest possible care. In an article he wrote, Dr. Peter Malliaras stated, ‘Participants in a recent international symposium about the condition agreed that the term Achilles tendinopathy is most appropriate.’ (1) 

Labels such as tendinitis and tendinosis are discouraged because: they imply specific biological processes that are currently debated and unclear. They may erroneously imply that certain treatments like rest may be sufficient for recovery; and the use of multiple terms among clinicians, the literature and other sources (eg, the internet) contributes to confusion and mistrust among patients.

Achilles diagnosis

The jury is out on whether symptoms resulting from an Achilles diagnosis are inflammatory or degenerative in nature. However, recently the research has shifted towards it being more degenerative in nature. This would mean that rest, and anti-inflammatories may be the wrong call here. We believe there is probably a bit of both, however, we do know that progressively loading the tendon is necessary for recovery. 

It’s important to note that it is not that the REST is bad, because the patient may start to feel better with less activity. However, without loading the tendon, the tendon does not go under any reparative processes. Therefore, when return to activity happens, recurrence is high. As you can see, using the correct terminology for foot conditions does matter.

Plantar fasciitis? Plantar fasciosis? Plantar fasciopathy? 

This is very similar to plantar fasciitis? Fasciosis? Fasciopathy? 

Plantar fasciitis: “itis’ refers to the heel pain being inflammatory in nature. This inflammation can come from trauma or inflammation that occurs with micro tearing after someone ‘Over does it’. This is treated similarly to how we treat any acute injury. Anti-inflammatories for a short period of time, rest. etc for ONLY A SHORT PERIOD of time. 

Plantar fasciosis: is the term used to describe the degenerated and non-inflamed phase of plantar fasciopathy (heel pain) caused by the degeneration (deterioration) of the plantar fascia which often occurs as a result of repetitive stress. 

This is typically how patients will present. Due to the fact that it is degenerative in nature, the above treatments are not recommended. Orthotics in conjunction with strengthening protocols for the foot may be warranted.  

Stem cell therapy is a newer treatment that is catching fire, although there are no guarantees. We highly recommend people see a clinician to build a treatment plan specifically based on their needs. 

A key point to note is that when there are bilateral symptoms, both heels, it is necessary to get bloodwork to identify if there is something systemic going on either delaying healing or increasing inflammation 

Plantar fasciopathy: is a generalized blanket term used to describe a long term overuse problem of the plantar fascia that causes heel pain. Plantar fasciopathy includes both periods of inflammation (plantar fasciitis) and periods of no inflammation where the plantar fascia is left degenerated (plantar fasciopathy).

Conclusion – Terminology for foot conditions

In conclusion, professionally we prefer to use the terminology for foot conditions consistent with FASCIOPATHY / TENDINOPATHY as both inflammation and degeneration are factors in the majority of these cases. However you may see us using the terms ‘itis’ here in our blog especially for lay people who are only familiar with those terms. If you’d like to train with us professionally, or get more content of this nature on an ongoing basis, check out our professional offerings here.

References

1. Malliaras P (2022) Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy 68:221–237

FAQs

1. Why is it important to use the correct terminology for foot conditions?

Using the correct terminology for foot conditions is important because it helps to avoid confusion and mistrust among patients. Inaccurate labels may lead to the belief that certain treatments like rest may be sufficient for recovery when they may not be. Additionally, using consistent terminology among clinicians and in the literature can help ensure that patients receive the highest possible care.

2. What is the most appropriate term for Achilles condition?

Dr. Peter Malliaras recommends the use of “Achilles tendinopathy” as the most appropriate term for Achilles condition.

3. What is the difference between plantar fasciitis, plantar fasciosis, and plantar fasciopathy?

Plantar fasciitis refers to inflammation in the heel area caused by trauma or overuse. The degenerated and non-inflamed phase of plantar fasciopathy (which results from repetitive stress) is called Plantar fasciosis. Plantar fasciopathy is a blanket term used to describe a long-term overuse problem of the plantar fascia that causes heel pain and includes both periods of inflammation and periods of no inflammation where the plantar fascia is left degenerated.

4. How should you treat plantar fasciosis?

Treatment for plantar fasciosis may include orthotics and strengthening exercises for the foot. Newer treatments like stem cell therapy may also be an option.

5. What should I do when there are bilateral symptoms of plantar fasciopathy?

When there are bilateral symptoms of plantar fasciopathy, it may be necessary to undergo bloodwork to identify if there is an underlying systemic issue that is delaying healing or increasing inflammation.