Plantar Fasciitis Series
Part 1 What is Plantar Fasciitis
The exact cause of Plantar Fasciitis is unclear but is linked to multiple factors involving mechanical stress and microtrauma. Common contributors include obesity or sudden weight gain, prolonged standing, and abnormal foot structures such as pes planus (flat feet) and pes cavus (high arches). Age can be a factor since Plantar Fasciitis most commonly affects adults between the ages of 40 and 60 due to the elasticity and shock-absorbing capacity of the Plantar Fascia decreasing as you age, and the progressive intrinsic foot muscles weakening and reduced ankle flexibility (leading to increased mechanical strain on the fascia during standing and walking). Gender can also be a factor since studies suggest that it is slightly more common in women, possible reasons include footwear choices (low-support shoes, thin-soled flats, or high heels) and ligamentous laxity due to hormonal changes (especially after menopause). Limited ankle dorsiflexion is a major risk factor as well.
Secondary risk factors include leg length discrepancy, excessive tibial torsion, femoral anteversion, and overtraining in athletes. In the elderly, symptoms often result from weak intrinsic foot muscles and acquired flatfoot. Calcaneal spurs are no longer a reliable indicator since many patients with heel spurs have no Plantar Fasciitis symptoms, and many with symptoms have no spurs.
Chronic Plantar Fasciitis/fasciosis involves collagen degeneration, extracellular matrix thickening, and micro tearing (like tendon overuse injuries). Long term pain involves tissue damage and central nervous system sensitization, so restoring pain-free movement is key to preventing chronic issues.
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