A Answers (5)
Rick Olderman, Physical Therapy, answeredThe plantar fascia on the bottom of the foot becomes inflamed when overused or overly stressed. Most plantar fasciitis is due to a combination of overly stretching the plantar fascia and excessive loading of the fascia. There are several factors that play into this: 1. the overall mobility of the foot into pronation or supination, 2. footstrike patterns, 3. the structural nature of the femurs (retroversion or anteversion), and 4. calf and soleus muscle length.
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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Exactly what causes plantar fasciitis is not well understood. But it probably develops as the result of repeated small tears in the plantar fascia. Normally when you walk, your plantar fascia stretches as your foot strikes the ground. If the plantar fascia is strained by the way you walk or by repeated stress, it can become weak, swollen and irritated ( inflamed ), and it can hurt when you stand or walk.
Conditions or activities that may lead to plantar fasciitis include:
- Things that affect how the feet work (biomechanical factors). These include abnormal inward twisting or rolling of the foot ( pronation ), high arches, flat feet, tight calf muscles or tight tendons at the back of the heel ( Achilles tendons ).
- Repetitive activities, such as jobs that require prolonged walking or standing on hard or irregular surfaces or sports such as running.
- Things that put extra stress on the feet, such as being overweight or wearing shoes that are poorly cushioned, don't fit well or are worn out.
- The natural process of aging. Plantar fasciitis is most common in middle-aged adults.
- In rare cases, a single injury to the foot.
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Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking difficult. The pain is usually worse in the morning, when you take your first steps, and after standing or sitting for a while. The injury to the tendon is usually the result of an accumulation of microscopic tears at the cellular level over time.
Jane Milliff, Physical Therapy, answered
Plantar fasciitis is an inflammation and micro tearing of the ligament that supports the arch in your foot-- the plantar fascia. When your foot hits the ground, the plantar fascia stretches to accommodate your body weight and the ground reaction forces generated by walking and running. During walking, up to 3 times your body weight is taken through your arch; when running, up to 9 times. If the condition develops, the person usually reports a sharp pain under their heel that may spread into the arch of the foot. The onset is typically not from an injury, but develops gradually and, if left untreated, gets worse over time. Many causes can contribute to plantar fasciitis:
- Standing on your feet all day with poor foot wear
- Increasing running intensity or distance too quickly
- Shoes inappropriate for your foot type or shoes that have excessive wear
- Poor foot mechanics (foot is too flexible or too stiff)
- Weakness in your core, hips, and lower leg
- Tight legs, especially calves
- Low back pathologies with nerve root irritation
- Poor running mechanics
To get better, one must address the particular issues that precipitated the pain. Having cushioned and supportive shoes is a first step.