Causes of Plantar Fasciitis

The most common cause of plantar fasciitis is poor range of motion in the foot and ankle joint. Repetitive motion such as running will cause this joint to wear down and result in pain and inflammation in the heel, the most common symptom of plantar fasciitis.

What is plantar fasciitis?

Dr. Luke Stringer: Plantar fasciitis is quite a common ailment that people suffer with and essentially in layman’s terms plantar is just the bottom part of your foot and fasciitis just means the fascia, which is some connective tissue that anchors kind of the ankle and the foot together. It’s just inflamed. And classic symptoms are just pain and inflammation in and around the heel or in the mid part of the foot. It can be really painful, especially in the morning when you get out of bed. That’s when quite a lot of people experience the most amount of pain. It’s really not fun, obviously, because if you’re upright you’re using your feet and your ankles, and plantar fasciitis can be quite painful and quite annoying.

Can repetitive impact activity like running, dancing or other sports cause plantar fasciitis?

Dr. Luke Stringer: Absolutely. And that’s usually what actually causes plantar fasciitis is the activity or the amount of activity that you’re doing. We’ll talk about this a little bit later on, but one of the main causes of plantar fasciitis, people think it’s just the amount of repetition you’re putting into the foot. If you’re a runner or you’re a dancer, you’re training for a marathon or you’re dancing in a ballet, obviously you’re continuously loading that foot and that ankle. It’s really important to have good ergonomics and biomechanics of the foot and the ankle. It essentially can cause it, but the cause is actually coming from usually limited range of motion in what we call dorsiflexion, that’s you actually flexing your foot and ankle towards you.

When we have limited range of motion in the foot and the ankle and then you do repetitive activity like running and dancing because you’re repetitively using the foot and ankle with a joint that’s not moving well, this breaks up and breaks down the fascia, which anchors your heel and your foot together. Over time that breaks down, forms adhesions, scar tissue and then that just leads to kind of pain, inflammation. Next thing you know, we’ve got plantar fasciitis. Yeah, absolutely those repetitive sports can cause it.

Does working or standing for a long period of time on a hard surface cause it?

Dr. Luke Stringer: It depends on what you quantify as work. If you’re just standing in one position on a hard surface, I doubt you’d kind of get specific plantar fasciitis. Could you get pain in the foot and ankle, the knee, the hip, the low back when you’re sedentary? Absolutely. Motion’s lotion so if you’re not moving over time, that repetitive stress is just going to break us down somehow.

Now, if you’re working, let’s say you’re in a factory and you’re walking around a bunch with big boots on and you have really poor ankle range of motion and you’re walking 5, 10,000 steps a day then yeah, absolutely. Walking on a hard surface is pretty unforgiving. That’s definitely going to put more stress into the joint, but again, it’s going to be the limited range of motion in the ankle, plus the repetitive stress of walking during work that can certainly break it down. Yeah, it could, but I don’t think standing would do it. It’d be more kind of the motion that would be kind of breaking that foot and ankle down.

Can the type of shoes you wear or even going barefoot cause plantar fasciitis?

Dr. Luke Stringer: Absolutely. I feel that our shoes nowadays have far too much support in them. They have those big spongy heels, it’s kind of like you’re walking on a cloud, you float along. Well then, you’ve got muscles, ligaments, tendons in the foot and when they’re working, they’re active and when they’re active they’re nice and stable so it’s going to support your foot and ankle. However, when we put these big, kind of comfy shoes on and then you’re doing the same activity, well, that’s essentially creating weakness in the foot and ankle because the shoe’s absorbing a lot of the force and it’s not really putting much pressure into the foot and ankle. That’s essentially going to create kind of lazy muscles, ligaments and tendons in the foot and ankle. I would lean more towards those big comfy supportive shoes doing more damage to the foot and ankle than those barefoot shoes.

Actually, really good rehab exercises we do in the office with people that are suffering with poor balance or pain in foot and ankle, we often do all that rehab in a barefoot because you can really grip the floor. You can switch on those muscles in your foot and then you can really build a strong and stable foot. Now let’s imagine you were wearing comfy shoes all week and then you went to the beach and you did a 5-mile run with no shoes on. Well, obviously you’ve gone from zero to a 100 really quickly, that could obviously create inflammation in the foot. You got to find that balance between if you’re wearing a comfy shoe, make sure you’re out of it a bunch, and if you don’t wear a comfy shoe and you prefer to be barefoot, make sure you’re not putting 10, 15,000 steps a day into that foot because as we’ve evolved, our foot and ankle isn’t necessarily ready to take that kind of force. Yeah, absolutely, footwear can play a huge role in neuromusculoskeletal conditions.

Can people be predisposed to getting plantar fasciitis by being overweight or having high arches or flat feet?

Dr. Luke Stringer: Yeah, I think so. Obviously if we’re talking about weight specifically, obviously if you’re overweight, you’re going to increase the load within your joints from your lower back, to your hips, your knees, your foot and ankle. Obviously if a joint is overloaded, well, it’s going to have to work harder. And if the joint’s working harder, well, the soft tissue that moves and stabilizes that joint is going to work harder so over time that’s going to break down quicker than someone who’s not putting too much load into the foot and ankle. Now is everyone who’s overweight or has a BMI going to get foot and ankle pain? Absolutely not. It’s going to be case specific. Now, if you added people who are high in their BMI and overweight with really poor ankle range of motion, then yeah, they’re going to have a higher incidence of kind of foot and ankle pain.

And then same with your foot. If you’ve got a high arch or a flat arch, that can also affect how you load your foot. Now, could it cause specific plantar fasciitis? Possibly, but possibly not at the same time. It’s quite a tough question to answer specifically, but yeah, the ergonomics of your foot can certainly affect how your foot and ankle functions. You can have too high of an arch, you can have too flat of a foot and that will certainly affect that foot and ankle and how it functions. And if you do have high arches or flat feet, you should certainly reach out to your chiropractor or podiatrist and look into getting some orthotics, just to create some even load into the foot and ankle. Because like we said, how you load a joint dictates how it moves and how much it moves dictates the stress and tension you’re putting into the tissue and that dictates how healthy the joint is. Yeah, you’ve certainly got to address those three factors when talking about foot and ankle pain, for sure.

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