Plantar Fasciitis: Current Concepts of Pathophysiology and Conservative Treatment

Background Plantar fasciitis is one of the most common causes of heel pain in adults, including physically active individuals and athletes. For many years, this condition was considered an inflammatory disorder; however, contemporary research indicates that in chronic cases a degenerative overload-related mechanism predominates, referred to as plantar fasciosis. This conceptual shift has important implications for the selection of effective therapeutic strategies. Aim The aim of this narrative review was to present current concepts regarding the pathophysiology of plantar fasciitis and to evaluate the effectiveness of currently used conservative treatment modalities. Materials and Methods A narrative review of the literature was conducted using the PubMed database. Original studies, systematic reviews, and meta-analyses addressing the pathophysiology, biomechanical factors, and conservative management of plantar fasciitis were included, with particular emphasis on recent publications as well as classical studies of fundamental importance. Results The literature analysis demonstrated that chronic plantar fasciitis is characterized by degenerative changes, such as collagen fiber disorganization and impaired tissue remodeling, in the absence of features of acute inflammation. Mechanical overload and biomechanical factors, including excessive foot pronation and restricted ankle joint range of motion, play a key role in pathogenesis. Conservative treatment, including activity modification, stretching exercises, physiotherapy, and the use of orthotic insoles, is effective in the majority of patients. In chronic cases resistant to standard therapy, extracorporeal shock wave therapy has proven effective, whereas corticosteroid injections provide only short-term analgesic effects. Conclusions Plantar fasciitis should be regarded as an overload-related degenerative condition, which should form the basis for selecting conservative treatment strategies. The best therapeutic outcomes are achieved through an individualized, comprehensive approach that addresses pathophysiological mechanisms and biomechanical factors.