Ask the c.Ped – What is Plantar Fasciitis?

Helen Russell is the owner of Metro Run and Walk with her husband Mark. She is a certified pedorthist and has completed several marathons!

There is no question that the most common “condition” we see is “Plantar fasciitis.”  Statistics that I’ve read indicate that 1 in 10 adults will experience Plantar fasciitis in their life.  Further, of people seeking medical treatment, it accounts for 10-15% of the foot problems treated and women are more likely to experience it  than men. 

Plantar fasciitis

(pronounced PLAN-tar fashee-EYE-tiss)

Plantar Fasciitis is an inflammation of the plantar fascia. “Plantar” means the bottom of the foot, “fascia” is a type of connective tissue, and “itis” means “inflammation”.  The Plantar fascia is a ligament that runs along the bottom of the foot connecting the heel to the base of the toes.  It is considered to be connective tissue in that it is a thick, fibrous band of tissue that along with the muscle and bones forms the arch of the foot.  The Plantar fascia derives its strength and health from the collagen fibers running through it.

Running, prolonged standing, and other activities involves constantly stretching the plantar fascia, sometimes causing degeneration to these collagen fibers and, most notably, to the fascia’s attachment point at the heel.  Once the fascia becomes irritated, it becomes inflamed and painful.

Think of the arch of the foot as a hunting bow and the plantar fascia as the bowstring. If you put pressure on the top of the bow or arch, it will tighten the plantar fascia and cause it to stretch. Weak foot muscles can lead to pressure on the arch. The shape of the arch, such as being flatfooted or running in old shoes which do not properly support your feet, can stress the plantar fascia. The Achilles tendon also attaches to the plantar fascia. If the calf muscles that attach to the Achilles tendon are tight, the ankle becomes less flexible, and the plantar fascia also tightens. ^{American Academy of Podiatric Sports Medicine}

Another reason that our plantar fascia becomes tighter with age is due to the difference in collagen chemistry between older and younger people. With age collagen becomes less elastic, and therefore more prone to tearing. A similar mechanism causes skin to wrinkle with age. The reduced activity of many adults and the differences in collagen chemistry between children and adults causes a tendency of the plantar fascia to become shorter, tighter, and more prone to tearing with age. ^{Stanislaus Orthopedics & Sports Medicine}

The most common complaint is pain in the bottom of the heel, which is usually worse in the morning and may improve throughout the day. This is because the fascia has an opportunity to tighten during the night or during periods of rest and is traumatically stretched upon initial weight bearing.

Over the course of the day, however, with increased activity, the pain may again worsen despite the fact that it frequently loosens up after the first few steps. The location of the pain may vary as well. While plantar fasciitis frequently is noticed under the heel, it may extend along the entire course of the fascia or at any point along the length of the fascia.

Risk factors for plantar fasciitis include:

Foot Arch Problems – High, Medium, and Low Arches

Obesity

Repetitive Stress –  Long distance running, especially running downhill or on uneven surfaces

Sudden weight gain

Tight Achilles Tendon

Shoes with poor arch support or soft soles

Current medical research indicates that plantar fasciitis is NOT an inflammatory condition, but an actual degeneration of the fascia – which is why most anti-inflammatory treatments, including rest and high dosages of anti-inflammatories, including cortisone injections, do not offer a cure, but only treat symptoms. As plantar fasciitis is often accompanied by weakness and inflexibility in the foot, leg, and hip muscles, current treatment recommendations consist of stretching and strengthening these areas. The goals of these treatments are the restoration of adequate blood flow to the area, and regeneration of the collagen. Therefore, the appropriate exercises and stretches are those specifically targeted to the foot, lower leg, thigh, hip, and back.

Related articles

• Questions to Ask Your Doctor About Plantar Fasciitis (everydayhealth.com)
• Plantar Fasciitis Causes Serious Heel Pain (everydayhealth.com)
• Why does the center of my foot hurt whenever I walk? (zocdoc.com)
• Self-Care Tool for Plantar Fasciitis (charlottesville-massage.com)