The plantar fascia is a thick tissue band in the bottom of the foot that connects the heel bone to the toe and forms the arch. Normally, the plantar fascia supports the arches of the foot and acts as a shock absorber for impact upon the heel. If excess or repetitive tension, stress, or stretching in the tissue occurs, small tears may form in the collagen fibers of the tissue, causing inflammation and irritation. This may occur from any activity that would cause overuse and repetitive pulling on the tissue.
Change in activity: An increase in weight or weight-bearing activity may precipitate plantar fasciitis, along with running greater distances or for a longer duration or on uneven surfaces. Walking barefoot, on the toes, on uneven surfaces, or up stairs may exacerbate symptoms. Shoes with poor support and fit may allow for tears to form, causing inflammation.
Diabetes: In patients with diabetes, plantar fasciitis may occur due to muscle atrophy, anatomical changes in the foot, and changes in gait.
Foot abnormalities: Plantar fasciitis was once thought to be caused by heel spurs, small calcifications in the foot. Research has found that this theory lacks evidence; however, up to one-half of patients diagnosed with plantar fasciitis may have heel spurs. Other abnormalities of the foot, including high arches, flat feet, stiffness (limited ability to flex the foot), or a tight Achilles tendon may cause plantar fasciitis. Arthritis that causes inflammation in the tendons may also contribute to plantar fasciitis.Normal wear and tear: The foot absorbs about 1.2 times the amount of body weight during normal walking. At running speed, the foot bears two times the runner's body weight. Over the years, normal wear and tear occurs in the Achilles tendon, plantar fascia, and heel pad. In the elderly, poor muscle strength, breakdown of the heel fat pad, and delayed healing, especially in combination with a high arch, may lead to plantar fasciitis.
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