ALL YOU NEED TO KNOW ABOUT PLANTARFASCIITIS
a quick summary / All you need to know about plantarfasciitis / what causes plantarfasciitis / treatment options / orthotics
What causes plantarfasciitis?
1 in 10 people will develop plantarfasciitis in their lifetime (6). Studies have found incidences of plantarfasciitis to be higher amongst the following groups of people (6).
- Middle-aged over weight females
- Young male athletes
- The athletic population
According to scientific literature, it appears that there is a strong correlation between increased weight and plantarfasciitis in the non-athletic population. With obesity being present in 70% of patients with plantarfasciitis (4).
It can take between 6 – 18 months for plantarfasciitis to resolve (7).
Often patients describe sudden, random onset of heel pain when they wake up one morning and don’t recall any ankle sprains, trips, falls or any other reason for this new and often intense pain. Any sudden large increase in stress, or small increases in stress over a longer duration, can be enough to cause change and damage within the plantar heel’s tissue. The source of this increase stress could be from something as simple as changing your footwear, running a little further than usual, poor diet or a perhaps training whilst dehydrated.
Biomechanical Causes
- Poor function of the calf plantarflexor muscles has been suggested to contribute to increased stretch on the plantar fascia (5). Specifically, intense calf muscle contraction may cause damage to the plantar fascia (1).
- Approximately 80% of people with plantarfasciitis has Over Pronated feet (2)
- Clinical studies have shown that heel spurs are unrelated to the medial arch height and can actually occur after surgical release of the plantar fascia (3).
Foot Alignment and Plantarfasciitis
A pronated foot can be described as the inwards tilt of the heel and the lowering of the arch of the foot. This is not always technically accurate, however it fits the narrative of the general public in defining the pronated foot as a “flat foot”.
As demonstrated in the image below, the left foot is a pronated foot. You will see from the image that the heel is tilted compared to the alignment of the right heel. The long arch of the left foot is “stretched” as the foot pronation increases. This in turn will strain the plantar fascia band tissue which runs under the arch of the foot. Therefore, the over pronated foot is associated with increased tensile stress on the plantar fascia, this predisposing the plantar fascia to injury.
It is important to restore foot posture in-order to reduce the stress on the heel and plantar fascia, therefore aid healing.
Tight Calf Muscles
Tight or weak calf muscles are related to an increase in plantar fasciitis. The literature also suggests that tight, weak calf muscles are linked to over pronated feet. It would therefore be essential to restore calf function by performing regular calf and foot stretch and strengthening exercises. Additionally, the foot posture may require realignment by wearing foot orthotics.
For accurate diagnosis of plantarfasciits and a treatment plan, it is very worthwhile to book a biomechanical assessment.
Literature cited:
- Cheung JT, Zhang M, An KN. Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clin Biomech (Bristol, Avon) 2006;21:194–203
- Cornwall MW, McPoil TG. Plantar fasciitis: etiology and treatment. J Orthop Sports Phys Ther. 1999;29:756–60.
- Hossain M, Makawana N. “Not Plantar Fasciitis”: The differential diagnosis and management of heel pain syndrome. Orthopaedics and Trauma. 2011. vol. 25(3), pp. 198–206.
- Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9:11–22
- Kibler WB, Goldberg C, Chandler TJ. Functional biomechanical deficits in running athletes with plantar fasciitis. Am J Sports Med. 1991;19:66–71
- Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872–7.
- Young CC, Rutherford DS, Neidfeldt MW. Treatment of plantar fasciitis. (477-8).Am Fam Physician. 2001;63:467–74.
