Understanding Plantar Fasciitis

Plantar fasciitis is an extremely common condition among athletes, but it also affects the general population, including even the most sedentary. How does this injury manage to target both the most active and least active in the population? The answer lies in the fact that there’s no one particular cause for the injury. It results from imbalances in the body, from a sudden change in activity that causes calf tightening or over stresses tissues, to a low back injury that affects someone’s gait pattern, to sudden weight gain that affects the distribution of pressure in the feet. The key to understanding this injury is identifying the change that occurred to cause it and then addressing that root cause.

The plantar fascia is a strip of connective tissue, or fascia, that begins at the heel bone and broadens out the cover of the bottom of the foot before attaching along the ball of the foot. It serves to support the arch, connect the foot bones, and absorb the shock of impact from each footfall, be it from running, walking or jumping.

With each step, the plantar fascia expands, stretching and spreading the distance between the ball of the foot and the heel. This stretch stores energy, that helps propel you when you push off to take the next step. For runners, in particular, the energy stored in the plantar fascia and Achilles tendon together account for 50% of the propulsive force during initial push off. For runners, in particular, plantar fasciitis is usually an overuse injury, and according to a runners world poll, 10% of runners will experience plantar fasciitis to some degree this year.

Plantar Fasciitis doesn’t just happen with overuse. It can result from a number of changes within the body, any of which can place stress on the fascia in your foot and lower legs, resulting in inflammation and pain. The Achilles tendon connects to the heel at the origin of the plantar fascia, meaning that dysfunction, imbalance, and tightness in the calf muscles can cause undue tension and stress to the plantar fascia.

With calf tension being one cause, that means something as simple as switching out your desk chair at work could be the culprit. Perhaps you switched to a taller chair to relieve neck and shoulder pain from a desk that was too high, but now your feet don’t quite touch the ground, and you spend the day with your toes down and heels raised. This passively contracted position in the calves can wreak havoc on your plantar fascia, and try as you might, until the root cause, namely your new desk chair, has been adjusted it’ll be hard to resolve the chronic pain in your feet.

That’s just one example of a seemingly unrelated activity that could cause calf tension. Others include a change in shoes, change in activity, or taking up a new sport such as biking. Even switching to heavier blankets at night in the winter can have an impact if you sleep on your back. The weight of the blankets can cause push down your toes, passively contracting the calves and putting stress on the plantar fascia.

Injuries and issues higher up the kinetic chain can also impact the plantar fascia, and a low back injury is also a common cause. A low back injury to the right side causes a slight limp, and as you raise your right hip to protect your back, stress is placed on the connective tissue down the left side of your leg as it tries to even out your gait and support your limping right side. As this tension cascades down the body, it can cause plantar fasciitis in the left foot, and eventually in both feet if not corrected because the pain from plantar fasciitis will affect your gait further, leading to an unfortunate feedback loop.

Common causes don’t end there. Imbalances in the feet can predispose an individual to plantar fasciitis. Flat feet can cause an over lengthened plantar fascia, and meaning that the foot is less able to function appropriately absorbing impact, leaving the body unable to cope with the stress of a sudden increase in activity. Similarly, raised arches pose the opposite problem and result in a tight contracted plantar fascia, that may not be able to stretch and flex under stress.

Other simple things such as hydration status can also play a role, as when the body is dehydrated all fascial structures are less pliable and are prone to injury.

The key to treatment is understanding the root cause of the injury. If the offending behaviors continue and the body is not able to adapt, then no amount of physical therapy or corrective measures can overcome continual re-injury. Examine your life for any recent changes, both increases in activity or decreases. Are there particularly tight muscle groups in your body or lose ones, especially in the hips, thighs and lower legs? Have you changed shoes or started working on a particularly hard surface? Whatever the cause, try to identify and correct it if possible.

In the meantime, some basic maneuvers to lessen the stress on the plantar fascia, such as calf stretching and gentle foot massage may help while you work out the root cause.