Plantar Fasciitis Causes

Plantar fasciitis-heel pain blog

My goal was starting this heel pain blog is to offer a forum from our clinic to help those individuals with heel pain and plantar fasciitis.

First I want to make it clear that not all heel pain is plantar fasciitis. There are many different potential pathologic causes. But, by far plantar fasciitis is the most common cause of heel pain.

My first entry will be a description of the process and factors that start this problem-plantar fasciitis.

Factors leading to plantar fasciitis of the heel are largely mechanical in nature. The onset of plantar fasciitis can be related to biomechanics and the overall foot structure. Examples include, repetitive microtrauma, unsupportive shoes, specific activities such as work on a ladder. This problem can start with an injury such as walking a long a river edge and literally getting a stone bruise. Or working on a ladder for more time than usual, especially in shoes or boots that are not protective enough. Gardening and using a shovel or spade and stepping down on the hard edge of the shovel with unsupportive shoes could also initiate this problem. Flip-flops, going barefoot or wearing shoes that don't offer enough support (especially on hard surfaces) can initiate this process. Those individuals that work on a concrete surface or warehouse are more vulnerable to plantar fasciitis. Those individuals that are overweight can also be prone to this problem. However if in individual is overweight and their foot hurts it's hard to exercise. So this becomes a catch 22.

This can either be the result of multiple microtrauma events or one significant single truamatic event. It can be the result of increased training. This can also be the result of poor biomechanics or foot structure. The plantar fascia is essentially the ligament of the arch. It goes from the heel bone extending forward to the base of the toes. When there is weightbearing pressure there is more tension within the fascia. This is especially true as one is walking or running and heel lifts up off the ground. The great toe bends upward, essentially pulling the plantar fascia with it. You can test this for yourself. When you are sitting down look at bottom of your foot and then bend the great toe up. You should feel the the fascia tighten up in the mid arch. At that moment the fascia is wound up quite tightly and there is tremendous longitudinal stress and tension within the fascia. This is called the windlass mechanism. Those individuals with a very high arch have a plantar fascia that is already "strung" quite tightly. These individuals are more vulnerable when there is additional tension or stress to the plantar fascia. Interestingly, those individuals with a very low arch can also have excessive tension within the fascia, this is because it is essentially trying to hold the arch up-because it is the ligament of the arch. Because of these various potential factors and/or causes, it is important to address these when treating this problem. Otherwise, the mechanical factors, if left unaddressed will keep this problem from resolving and healing.