what causes plantar fasciitis?

What Causes Plantar Fasciitis?

In Standard by Bigfoot

TL;DR it’s more likely than not that your shoes are causing your plantar fasciitis.

To be more precise, the everyday activities you engage in from walking to running and everything in between are being performed in inappropriate footwear that is slowly but surely damaging your foot. There are likely additional complicating factors (we’ll get to those later), but your choice of kicks and the position they put your foot in is the biggest culprit of your constant discomfort.

Don’t believe us? Check out this study and its remarkable conclusion:

“People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. The range of their foot motions are remarkably great, allowing for full foot activity. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Children should not be encouraged to walk prematurely and should not wear any footgear until absolutely necessary. Footgear is the greatest enemy of the human foot.”The Journal of the National Association of Chiropodists

The evidence is pretty compelling.

It’s amazing that in this day and age the answer to what causes plantar fasciitis remains something of a mystery. It’s such a common ailment; in fact it’s the most common condition podiatrists treat patients for on a daily basis. Millions around the world suffer with this condition.

Here’s a common scenario: Patients, with the best of intentions, see their doctor complaining of heel pain. Usually this pain is worse in the morning or after long periods of sitting or standing. They complain of pain and discomfort near the heel bone and also may be experiencing pain in their arch or on the outside of their foot. The diagnosis is typically plantar fasciitis and a few traditional methods of treatment like icing, anti-inflammatories, orthotics and rest are prescribed and the patient is sent on their way without really getting at the root of the issue.

However, upon learning that they have been diagnosed with plantar fasciitis (or fasciosis; but that’s a discussion for another article), questions like “What causes plantar fasciitis? What can be done? Why is it so common? How do I treat it?” begin to crop up as treatment fails and these questions often times go unanswered.

The purpose of this article is to provide you with an answer to the question what causes plantar fasciitis and provide a quick overview about what can be done for long-term relief and prevention of plantar fasciitis recurrence.


What Causes Plantar Fasciitis?


What you’ll get in this article:

What Causes Plantar Fasciitis – Anatomy of the foot
What Causes Plantar Fasciitis – The Root Cause
What Causes Plantar Fasciitis – What about my shoes is so bad?
What Causes Plantar Fasciitis – Why Traditional Treatments (Usually) Don’t Work
What Causes Plantar Fasciitis – Complicating Factors
What Causes Plantar Fasciitis – The Cure

Let’s start with an anatomy lesson.


What Causes Plantar Fasciitis – Anatomy of the Foot


All of us have a very strong fibrous band on the bottom of our foot that runs from the heel bone to our toes. It’s as wide as the heel and spreads out as it approaches the toes into 3 bands – a lateral band, a central band and a medial band. This is the plantar fascia.

Over the past several years, an increasing number of people have been experiencing pain typically right on the bump of the heel bone and, sometimes, on the fascia ligament itself near the arch.

These are the people (and you’re probably one of them) that wake up first thing in the morning, hop out of bed and upon putting their foot down experience pain and discomfort. They limp around for a little while until the blood flow starts and their foot warms up.

It’s been commonly held that this pain is associated with an inflammation and tearing of the plantar fascia caused through overuse or, at times, through a single traumatic event of over-exertion. This is what’s known as plantar fasciitis.


What Causes Plantar Fasciitis – The Root Cause


As it turns out, doctors discovered that in most cases, this wasn’t an inflammation or fasciitis at all, but rather fasciosis, which is dead or necrotic tissue.

A few years back doctors took tissue samples from dozens of plantar fasciitis patients to study what they thought would be tears and inflammation in the tissue. What they found, almost without exception and to their surprise, was dead tissue.

The questions then became, what causes plantar fasciitis? How do we treat this problem? And what in fact is the problem?

Tissue replenishes itself on an on-going basis. Think of it like waves on a beach. If you make footprints in the sand (in this case the “damage”) the waves will return and wash those away providing a smooth, fresh palate for you to work on.

Similarly, new blood infuses tissue in our bodies with life-giving sustenance and regeneration while the blood being pumped out washes away impurities. If something impedes that blood supply, especially over a long period of time or use, then the tissue is not regenerated properly and serious damage can occur.

So what would cause something like this in your foot? The answer, as it turns out, is fairly simple and breathtakingly obvious when you think about it.

When you slide on a pair of socks, step into your shoes, lace them up and head off to a day at work or school, do you ever think about what’s happening to your toes? Most shoes today are designed with a fashion-first mentality, utility and comfort second. These shoes provide “comfort” and “protection” but you’ll also notice many of them provide three things that are absolutely damaging your foot: a tapered toe box, a lifted toe spring and an elevated heel.

What happens inside is a bit of a nightmare when it comes to your foot health. Your big toe gets pushed over toward your other toes and the soft tissues in your foot all the way back to the heel get pulled in and forward.

DIY – Restricted Blood Flow
Check it out for yourself. Remove your shoes and socks, put your foot on the ground and push your big toe in toward your other toes. You’ll see a triangular shape above your arch. This is the abductor hallucis. You’ll notice this tissue being pulled in and forward. The problem with this, aside from potential toe issues discussed below, is the fact that the blood supply carried to your plantar fascia runs through an artery that can become restricted by this constant pull. No new blood means your tissue isn’t being properly regenerated.

The result? You’ve just answered the question what causes plantar fasciitis.


What Causes Plantar Fasciitis – What is it about my shoes that is so bad?


child's foot

Let me take you back. Way back – to when you were just a little baby and had yet to take a single step. Your foot is an amazing creation of nature and works about as perfectly as possible right out of the box, so to speak. Take a look at the image above. This is a young foot; natural and healthy. You’ll notice that the widening of the foot runs from the heel and extends to the tips of its toes. You can also see there are natural spaces in between each toe. The bare foot is great for standing, walking, running and all sorts of other activities.

However, when the time is right, we forget about this perfect design and begin to cripple our little ones right from the get-go in a modern, albeit less barbaric, version of foot binding . We put them into cute little shoes that are too narrow and rigid for the foot and this begins a lifetime of unnatural alignment. This is a first glimpse into what causes plantar fasciitis.

As life goes on, this baby grows to toddler, to childhood to adulthood wearing shoes, boots, sneakers and so on that compress toes into a more triangular shape that works contrary to the natural functions we’re born into. This has become the social norm whether it is for fashion, or practicality or for whatever reason – and we accept it as a society because we don’t fully grasp the function of the toes as it relates to our foot health.


The Terrible T’s – Toe Box, Toe Spring and The Elevated Heel


Most of the shoes you’ll find on the market today are made to sell – they are stylish, flashy and are marketed for specific uses. However, most of these have a few characteristics in common that are causing some serious problems: a tapered toe box, a lifted toe spring and an elevated heel.

Toe Box

The toes are critical for our sense of balance and they provide power when we propel ourselves in the act of walking or running. Providing proper room for a natural toe splay allows our toes to grasp the ground and involve all the functions of the foot from heel to toe.

When our toes are not properly spaced, our legs and upper bodies are forced to make compensations for the instability of our toes and our gait is less balanced and less efficient. The foot is often placed into an imbalanced position and soft tissue is pushed and pulled in unnatural directions. Most people begin to lose the full function of their toes early in life because almost all shoes have a narrow toe box that pushes the toes together. We make compensations for our poor walking form caused by this lack of toe space, but the cost of these compensations is some degree of foot deformity, leg and back pain and abnormal gait.

high heels and pointed toe boxWhy do we stand for this? Certainly there isn’t enough information or education out there about the problems we’re causing ourselves. Our poor foot position comes from the way our toes are placed and we just accept it because that’s just how most shoes are built.

The common sense approach to this would be to find shoes that allow you to spread your toes out and on the ground. Those requirements in and of themselves disqualify a huge chunk of shoes available on the market today. Most shoes have a tapered toe box. Most have an unnatural toe spring and many have an elevated heel. An example of a shoe that would be healthy is a shoe that is something like a Crocs, a Birkentock or a Lems or Altra.

The options are somewhat limited, and since the big shoe companies and manufacturers aren’t likely to do a 180 on their design style and cosmetics, you’re going to have to do a little more “legwork” to find the right type of shoe – whether it’s online or a local shoe store with models that have adequate toe box.

DIY - Toe Box
Find shoes with a removable insole and stand in them with your preferred pair of socks. Spread your toes apart and if no part of your foot expands beyond the insole, especially your toes, that shoe may work for your feet.

Find shoes with a removable insole and stand in them with your preferred pair of socks. Spread your toes apart and if no part of your foot expands beyond the insole, especially your toes, that shoe may work for your feet.

Even among the brands with a wider toe box you will find that it is still too tapered, narrow and pointed than your foot with a wide toe spread. However, the wider the better, and a little room is better than no room at all.

Not only is the tapered toe box in popular footwear a contributing cause in many plantar fasciitis cases, but it’s also a leading cause in many of these other conditions:

  • Ingrown toenails
  • Calluses
  • Heel Pain
  • Bunions
  • Bursitis
  • Athlete’s foot
  • Corns
  • Hammertoes
  • Blisters
  • Tendon imbalances
  • Metatarsalgia
  • Toe fungus
  • Morton’s neuroma

You’ll notice that the above list includes some of the most common foot problems that are regularly treated by foot doctors. What’s missing from treatment, many times, is prevention education. Instead, the sad reality is that reconstructive surgery is often recommended for these conditions. No education is given to patients to modify lifestyle choices such as their choice in footwear.

Also interesting to note is that these problems occur very rarely in cultures where shoes are not worn, but they are exceedingly common in our shoe-wearing culture. Is this a function of evolution? No, it’s simply the fact that the shoes we wear are doing harm to our natural foot function.

Toe Spring

Toe Spring is a common, almost ubiquitous feature on most shoes – especially athletic shoes where it tends to do the most damage.

To get an idea what toe spring really is, take a look at the images below. The image on the left features the standing position of the human foot in its natural form. The image on the right is a popular athletic shoe. Now, take a close look at the toes and compare where they sit on the ground compared to where the toe area of the shoe sits. Why is that elevated while the human toe isn’t?

natural  toe and foot positiontoe spring

Toe spring is the elevation of the toe box in footwear. The typical elevation angle is around 15 degrees. So why are shoes made this way and what is the supposed function? I’m glad you asked. Toe spring is added to the design of the shoe to create a rocking motion as a substitute for the normal mechanics of the foot.

DIY – Toe Spring
If you have a pair of shoes (especially athletic or running shoes) place one on a flat surface then press down on the front of the shoe directly over the toe box. You’ll see a rocking motion. Now do this with your foot. Wait a minute, you can’t because your foot is planted firmly on the ground as nature intended.

So what does this mean for your feet? There are a few things that can happen as a result of an elevated toe box and they are all bad. If your toes are off the ground most of the time even when you are standing flat-footed, you are placing the muscles on the underside of your foot into a stretched position and restrict their ability to generate force. Normally your toes would be pressed against the ground providing stability and force supporting the arch. As the muscles weaken more stress is placed on ligaments and your foot is thrown off its natural system of balanced pulling.

This pulling imbalance also contributes to many of the foot problems mentioned in the section above, as well as participating in imbalances created in the lower leg and knee since the muscles that send the tendons to the ends of the toes, take their origin from the lower leg and surrounding structures.

In case you were not previously concerned with your toes, hopefully you are now. They deserve to be comfortable and placed into a shoe that is shaped like your foot and spread at the toes.

Elevated Heel

As if toe box and toe spring weren’t bad enough on their own (or together), there is an additional concern in many styles of shoes. From high heel pumps to running shoes, it seems we can’t get away from elevating the heel of our footwear and this contributes to the previously mentioned unbalanced pull of tendons from ankle to toe and everything in between.

This elevation puts unnecessary stress on the ball of our foot that in turns stresses all the other areas of our foot from heel to toe. In order to perform their function correctly, our toes need to remain firmly against the ground as the whole body passes over them during normal foot functions like walking and running.


What Causes Plantar Fasciitis – Complicating Factors


As mentioned throughout this article, your plantar fasciitis (or fasciosis) is most likely a casualty of your footwear.

However, there are additional complicating factors that commonly contribute to this condition. Below is a list of these complicating factors and a short description. They are worth mentioning and may or may not have something to do with your plantar fasciits.

Calf muscle shortening – Tightness in your calf muscles is a fairly common problem that causes quite a bit of discomfort. Many people who work out frequently complain of this condition. It’s more common among runners but can be experienced by those engaging in jumping or plyometric exercises. Another thing that can contribute to this condition is your choice of footwear – especially if you spend the day in an elevated or high heel.

If you walk around in shoes with an elevated heel or wear high heels much of the time, the muscles in your calves are more prone to shortening since your heels are constantly raised. This shortening causes tension in the Achilles tendon that connects your calf muscles to your heels. In some cases, the shortened tendon can become inflamed leading to Achilles tendonitis. The muscles that attach to your heel through the Achilles tendon and the whole mechanism become susceptible to injury when your calf muscles are tight.

On the other hand, sitting too much can cause calf muscle shortness. When you sit in a chair for long periods of time, your calf muscles shorten. This can make tight calves feel even tighter. It’s best to find a good balance of physical and sedentary activity.

Your best bet if this is something you deal with is to change your regular footwear and start a stretching program that focuses on your calf muscles and your hamstrings to prevent calf tightness after a workout. Use a foam roller to do self-myofascial release beforehand. Do calf stretches every one to two hours when you’re sitting or walking on your computer and do regular core-strengthening exercises.

Plantar fascia contracture – So why does your heel hurt more in the morning after you get out of bed? This is due to your plantar fascia tightening up (or contracting) while you’re asleep.

Some have found relief from this by wearing night splint to bed. The night splint holds the foot in in a neutral position and contracture is prevented. Others have found more relief out of dynamic stretching like rolling a golf ball under their foot first thing in the morning.

Obesity – There are numerous health complications linked to being overweight. When it comes to foot health it’s pretty simple: additional weight applies an additional load of stress on your foot and its tendons, ligaments and muscles don’t become comparably stronger. This can lead to all sorts of issues and can be a complicating factor contributing to plantar fasciitis.

Heel spurs and plantar fasciitis is the most common problem seen in overweight patients. The undue pressure on the longitudinal arch puts a “pull” on the origin of the Plantar Fascia at the heel. This continued stress on the fascia allows for the formation of heel spur as well as plantar fasciitis.

Pronation – Pronation is the most common and damaging medical problem that may occur as a result of flat arches. Pronation is a turning out of the foot at the ankle, so there is a tendency to walk on the inner border of the foot.
You can test for pronation by looking at the leg and foot from the back. Normally you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon will run straight down the leg, but when it lies on the heel, it will twist outward.

Rheumatoid arthritis – Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels.

Although rheumatoid arthritis can occur at any age, it usually begins after age 40. The disorder is much more common in women.

Reactive arthritis – Reactive arthritis is joint pain and swelling triggered by an infection in another part of your body — most often your intestines, genitals or urinary tract. Your knees and the joints of your ankles and feet are the usual targets of reactive arthritis.

Although reactive arthritis is sometimes called Reiter’s syndrome, Reiter’s is actually a specific type of reactive arthritis. In Reiter’s, inflammation typically affects the eyes and urethra, as well as your joints. This might contribute to other conditions like the one you are suffering from

Psoriatic arthritis – This is a condition that features red patches of skin topped with scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling.

Corticosteroid injections – Cortisone shots are injections that may help relieve pain and inflammation in a specific area of your body such as your ankle, elbow, hip, knee, shoulder, spine and wrist.

However, Cortisone shots carry a risk of complications, such as death of nearby bone, joint infection, nerve damage, thinning of skin and soft tissue around the injection site, temporary flare of pain and inflammation in the joint and tendon weakening or rupture

Why would you ever do this to treat something that is likely dead or, at worst, inflamed tissue? Not only are you simply trying to mask the pain, but you’re also subjecting your condition to something that could possibly make it worse!


What Causes Plantar Fasciitis – Why Traditional Treatments Don’t (Usually) Work


Doctors have been treating for tears and inflammation by jacking up the arch with orthotics, injecting the foot with cortisone, prescribing anti-inflammatories and sending patients to therapy. This treatment hasn’t worked for too many patients because it does not in fact treat the correct problem.

As discussed earlier, cases of “plantar fasciitis” are more often than not “fasciosis” with resultant dead tissue. The tissue needs to be regenerated – there is no inflammation, no tears, it’s not the lack of arch support. It’s the entire foot out of balance. Toes aren’t spread with improper footwear. The foot is off-balance and muscles and other soft tissues are over-strained and the result is dead tissue.

You need to get the blood flowing, the foot strengthened and the toes involved. Only then will your body heal itself properly.


What Causes Plantar Fasciitis – The Cure


Click here for our treatment guide. (coming soon!)

In the meantime, here’s a quick list of do’s and don’ts:

Do:

• Assess your current footwear choices and make changes that will lead to increased foot balance and health. Click here for our top suggestions for a range of “healthy” shoe choices.
• Get adequate rest
• Get on an aggressive treatment plan that includes dynamic stretching and lower leg and foot strengthening exercises
• Walk barefoot
• Keep your toes spread and active

Don’t:

• Get surgery
• Get a cortisone injection
• Continue to wear your shoes that feature a narrow toe box, an elevated toe spring and high heels.
• Use inserts or orthotics
• Use a walking boot

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