Plantar Fasciitis – Part One
This is part one in a four part series about plantar fasciitis.
From here on out, I’ll use PF instead of spelling out plantar fasciitis.
Part One is an introduction and overview of the plantar fascia structure, symptoms of PF, and who “gets” PF.
Part Two will cover one of the most important roles of the plantar fascia in gait. I’ll speak to the idea that PF is thought to be a foot issue about inflammation, but science may not back that up. Additionally I’ll give some information on the prognosis of PF once you have it.
Part Three covers the management of PF.
In Part Four I’ll tell my personal tale of two bouts of PF – one in the left foot about 10 years ago and one more recently in my right foot. I’ll let you know how I managed the second round of PF in that right foot and how it made the quality of my life and movement WAY BETTER while it was occurring.
So here we go with Part One…..
Last summer a friend I was backpacking with begin to grapple with incredible increasing foot pain beginning about 15 miles into the trip.
Backpacking is not an ideal place for this to happen because, well, you either have to backtrack or push on over rugged terrain ascending and descending high mountain passes while carrying everything you need on your back.
Getting in the car and driving to urgent care wasn’t a choice as this acute flare up of PF came on like gang busters.
Once home, the foot pain was diagnosed by a proper doctor as PF.
Those of us who have grappled with PF understand that there is never a great place for the painful and persistent symptoms to arise. The intense foot pain can be really scary and honestly, it hurts like hell.
What is the Plantar Fascia?
The plantar fascia is a thick fibrous tissue on the sole of the foot, running from the heel to the toes, and is thicker/denser near the heel and broader and thinner near the toes.
https://en.wikipedia.org/wiki/File:PF-PlantarDesign.jpg
It serves to separate, support, and connect muscles and structures of the foot.
It has incredible tensile strength, providing shock-absorbing qualities for weight bearing activities and supporting the rotating movements in the bones of the foot during movements of ambulation like stepping and running.
The plantar fascia helps to support the longitudinal medial arch, as well as the transverse arch which is located across the top of the foot from the longitudinal medial arch to the outer border of the foot.
The anatomical shape and placement of the plantar fascia create a stretch tension on the sole of the foot that prevents longitudinal arch collapse (Bolgla & Malone, 2004).
Research suggests that the plantar fascia plays a role in proprioception: the sense we have of the position of our body parts in space (Stecco et al., 2010). It helps our brain perceive ankle and foot motions in order to help us balance, move, and function on varying terrains.
It’s good to remember that the fascial tissue system is integrated throughout the body and although the plantar fascia is located on the sole of the foot, it is contiguous with and in relationship to the fascia through the ankle, up the leg, into the pelvis, and into the trunk. This suggests the importance of the foot as our foundation and its relationship to the entire system.
In a nutshell, the plantar fascia works to receive information (load and proprioceptive) and translate it into shock absorption, support, and load distribution.
It’s got a big job at the bottom of our entire structure.
Symptoms and Who Gets Plantar Fasciitis (PF)?
Symptoms
The most common symptom of PF is the onset of sharp localized pain near the inside of the heel (Kaliniev et al., 2013). This is where the plantar fascia originates from the inner aspect of the calcaneus/heel bone (refer back to plantar fascia photos above).
This sharp inner heel pain is typically more pronounced upon waking and taking the first few steps, standing or walking after any prolonged sitting/period of rest, and long periods of standing (Kaliniev et al., 2013).
Because the plantar fascia is ultra responsible for distributing load bearing through the foot complex, there are three things that may aggravate a case of PF:
1. Activities like standing, walking, and running
2. Shoe choice
3. The environment/terrain one is moving on
Who Gets PF?
Depending on the research source, PF accounts for about 10 – 15% of all adult foot complaints (Hancock et al., 2016). This makes it a “common” orthopedic issue reported to health care practitioners.
PF is seen across a broad spectrum of the population and there is little scientific evidence that one group has a higher risk, but it is correlated to repeated trauma of the plantar fascia (Hansen et al., 2018).
Hansen et al. (2018) suggest that risk factors for increased plantar fascia trauma are:
1. A higher body mass index
2. Sudden weight gain
3. High or increased training volume for runners/walkers/hikers/athletes
4. Standing occupations
5. Limited ankle dorsiflexion
6. High foot arches
7. Foot/ankle pronation (rolling inward)
All of the above risk factors can be associated with repeated trauma to the plantar fascia, especially at its origin on the inside (medial) aspect of the heel bone (calcaneus) – see the photo above pointing to typical location of pain.
In other words, the risk factors in and of themselves do not necessarily result in lower extremity/foot issues, but may play a role in why some folks end up with PF.
The foot is an incredibly mobile segment of our body with 33 bones and 26 joints. Some of the above risk factors make controlling foot motion over time quite difficult (repeated trauma), which can increase the potential for PF.
For instance, overpronation (foot/ankle rolling inward) can lead to excessive foot mobility. Higher arches correlate to a lack of foot mobility. Higher body weight increases the load on the foot and the plantar fascia. Increased training volume or standing jobs increase the likelihood that the plantar fascia has to deal with increased load distribution and support through the foot.
You’ve heard me say in class that just because you have a risk factor for something does not mean you will end up with that thing. In other words, just because you pronate doesn’t mean you’ll end up with PF.
You’ve also heard me say in class that working on strength, mobility, and awareness in the foot each day is probably a really good thing to do whether you have feet that bother you or feet that seem perfectly happy. They are the foundation of our entire system, linking us to the earth, to movement, to stability, to balance.
I’ll address some simple activities you can play with for your feet in Part 3 of this series.
In the meanwhile, consider spending a few minutes each day walking bare foot in your home or outside and really paying attention to the way each foot lands, pushes off the ground, how the toes work/spread/don’t spread, what your ankle does, whether your feet face forward/turn out/turn in, whether each foot seems equal in how much of your bodyweight it assumes…. begin to pay attention. In my humble opinion, this truly is what yoga has asked me to do for the last 30 years… pay attention.
References
Bolgla, L.A., & Malone, T.R. (2004). Plantar fasciitis and the windlass mechanism: A biomechanical link to clinical practice. Journal of Athletic Training, 39(1), 77 – 82.
Hancock, C.L., Baker, R.T., & Sorenson, E. A. (2016). Treatment of plantar fascia pain with joint mobilizations and positional release therapy: A case study.International Journal of Athletic Therapy & Training, 21(4), 23 – 29.
Hansen, L., Krogh, T.P., Ellingsen, T., Bolvig, L., & Fredberg, U. (2018). Long-term prognosis of plantar fasciitis. The Orthopaedic Journal of Sports Medicine, 6(3), 1 – 9. doi: 10.1177/2325967118757983
Kaliniev, M.A., Krastev, D., Krastev, N., Vidinov, K., Ventchev, L., & Mileva, M. (2013). Abnormal attachments between a plantar aponeurosis and calcaneous.Clujul Medical, 86(3), 200 – 202.
Stecco C, Macchi V, Porzionato A, Morra A, Parenti A, Stecco A, Delmas V, & De Caro R. (2010). The Ankle Retinacula: Morphological Evidence of the Proprioceptive Role of the Fascial System. Cells Tissues Organs, 192, 200-210. doi: 10.1159/000290225
