Understanding Plantar Fasciitis: Causes, Symptoms, and Treatment

Illustration of plantar fasciitis with labeled areas of the foot.

“Plantar Fasciitis” by Access Ortho, used with permission. Access Ortho is a registered trademark of Access Ortho Pty Ltd. Website: https://www.accessortho.com.au/plantar-fasciitis/

It is useful to begin with the anatomical meaning: plantar means foot and fascia means band. The plantar fascia is a band of ligament close to the sole of the foot, which spans across the arch, from the heel bone to the ball of the foot. This ligament is one of the most important elements of the foot's structure, as it provides foot support and critical rigidity throughout the gait cycle.

When you take a step, the heel and ball of your foot hit the ground first. As your weight is applied, the tibia (bone in your lower leg) turns inward and the foot pronates, or in other words, the arch flattens. This stretches the plantar fascia ligament. The flattening of the arch and stretching of the plantar fascia absorbs shock and allows the foot to accommodate to irregularities in the walking surface.

So the plantar fascia functions as a tension bridge in the foot, providing both static support and dynamic shock absorption. Any adverse condition effecting the plantar fascia can cause disruption of daily activities such as standing, walking, and running. It can result in both acute and chronic pain - as you may well know.

'Plantar Fasciitis is the most common cause of pain in the heel, estimated to account for 11-15% of foot symptoms requiring professional care.'

 

What Causes Plantar Fasciitis?

  • While the exact cause of plantar fasciitis is poorly understood, we can assume that it is probably multifactorial. It is well known that plantar fasciitis can occur in association with various arthritides (resulting in inflammation and swelling), but in approximately 85% of the cases, the etiology is unknown.
  • Increased body-mass index significantly increases the risk of plantar fasciitis. A matched case-control study found that limited ankle dorsiflexion, obesity, and prolonged weight bearing at work play a role in the etiology of plantar fasciitis. Mechanical overload, whether the result of biomechanical faults, obesity, or work habits, may contribute to the symptoms of heel pain. Findings also indicate that tightness of the Achilles tendon as mentioned, and inappropriate shoe wear may contribute to the onset of plantar fasciitis. There is even evidence that the posture that the individual adopts during sleep could influence the contracture of muscles, causing or worsening his/her plantar fasciitis pain.

Causes of Plantar Fasciitis - High Arch

  • While unproven, many articles have proposed that plantar fasciitis may be due to a lack of cushioning in a rigid, high arched foot. Individuals and athletes with pes cavus, high arched feet, have increased stress on the plantar fascia with foot strike. When not corrected, the high arch causes the plantar fascia to become too tight, and the calf muscles and Achilles tendon to also tighten; this causes the plantar fascia to not effectively extend in the heel strike phase of walking.

Causes of Plantar Fasciitis - Flat Foot

  • Recall that flattening of the foot as a natural part of shock absorption in walking stretches and releases the plantar fascia. The foot that is always in a state of over-pronation puts ongoing tension on the plantar soft tissues and potentially creates injury.
  • Many authors have pointed out that an increased stretching in a flat foot, or by stretching during over pronation of the foot could be a cause of plantar fasciitis. Alteration of the walking and running biomechanics, by flat feet, may increase plantar fascia stress; as the arch collapses it creates excessive stress on the plantar fascia. When not treated, the low foot arch causes the foot ligaments to loosen - so that the supporting force to the foot arch is weak. This causes undue weight loading on the plantar fascia.

Treating Plantar Fasciitis

  • Most healthcare providers will agree that plantar fasciitis can be a frustrating disorder to successfully treat; success is more likely with a comprehensive treatment program rather than with a quick fix.
  • Of the wide variety of management strategies, the treatments that should likely be attempted first are those that are low-cost and low-risk. A trial of conservative therapies is generally advised for plant fasciitis before more invasive treatments are attempted.
  • Examples of conservative care would be physical and/or chiropractic therapy, soft tissue therapy/massage, taping, night splints, stretching, strengthening, resting, and orthotics. There are more invasive treatment options, such as injections, medication, shock wave therapy, and surgery. Typically, surgical options require a prolonged recovery, and often does not allow for full function.

At Home Treatment Options - Stretching

  • Stretching of the planar fascia and Achilles tendon is considered to be one of the hallmark treatments in the management of plantar fasciitis. The goal of a stretching program is to relieve the stress put on the plantar fascia by either the plantar fascia itself being tight or the fascia being tightened by a tight Achilles tendon, as both the plantar fascia and Achilles tendon insert onto the calcaneus. Stretching exercises are central to most plantar fasciitis treatment protocols.
  • Multiple randomized controlled studies have shown that stretching exercises improve recalcitrant heel pain within a reasonable time frame. A plantar fascia-stretching protocol is an important component of treatment. It provides you with an effective, inexpensive, and straightforward treatment protocol to treat plantar fasciitis.
  • View the Plantar Fasciitis/Heel Pain - Stretching Tips video on YouTube. Greg Thorpe, M.P.T., A.T.C visually shows you how to complete each exercise.

At Home Treatment Options - Taping

  • Taping of the foot provides medial arch support for plantar fasciitis patients and potentially removes strain from the plantar fascia. A 2006 study in the Journal of Ortopeaedic & Sports Physical Therpay found that two treatment sessions of the calcaneal-taping technique results in a significant reduction of pain. The same study found the calcaneal taping is an effective tool for relief of plantar heel pain, especially as a precursor to long-term management through orthotics. By taping the affected foot, repetitive injury to the plantar fascia can be avoided and tissue repair can be facilitated.
  • We reccomend that the tape not be left on your foot all dau and night as it may prevent the skin from being able to breathe. As well, the foot should be cleaned with a non-moisturizing soap prior to taping.
  • For a descriptive explanation, view the Heel Pain Plantar Fasciitis - Tape Wrap Procedure video, available on YouTube.

Orthotic Treatment Options

  • The aim of orthotic therapy is to reduce strain on the plantar fascia by cushioning and elevating the heel and/or providing medial arch support. Semi-rigid orthotics significantly reduces pain experienced during walking, and reduces pain and disability for patients with chronic plantar fasciitis. One primary advantage of this option is that treatment for pain relief can commence immediately.
  • Orthotics may also be useful for overweight plantar fasciitis patients, as they help reduce shock and cause more even weight distribution over the plantar fascia and its insertion on the calcaneus.
    Custom-made orthotics may also be a suitable option in the beginning stages of treatment; however, they are far more costly than prefabricated orthotics. In a trial involving 236 participants, prefabricated shoe inserts were found to be superior both to using custom-made orthotics as well as to stretching alone.
  • Findings such as these continue to inform a consensus in current research that there are no statistical advantages to custom orthotics. Prefabricated orthotics allow for a combination of maximum comfort for the patient, immediacy of pain relief, and affordability.
  • While selecting prefabricated, or custom-made orthotics, it is vital that you select orthotics that are uniquely designed to correct your specific foot type. For example, if you have a flat foot, using an orthotic for high arches might increase the stress on the plantar fascia and visa versa. Utilize the how to determine your foot type guide, to ensure that you are using orthotics that are specifically designed for your feet.

Foot Type and Orthotic Selection Explained

  • Orthotics (insoles) can actually worsen plantar fasciitis if they do not properly match your foot type. The micro-tears causing your pain result from stress on the plantar fascia, which can occur from either a high, rigid arch or a flat arch. It’s essential to address plantar fasciitis with the correct type of orthotic.
  • If you have a flat foot, the best orthotic focuses on correcting pronation (“Type 1” foot). If you have a high arch, the best orthotic addresses supination (“Type 3” foot). For a neutral arch, you should prioritize comfort and support. This link explains how to determine your foot type and provides our recommended orthotic correction to best match your specific foot structure.

References

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