{"id":1483,"date":"2024-03-12T17:07:14","date_gmt":"2024-03-12T21:07:14","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=1483"},"modified":"2025-10-17T19:31:06","modified_gmt":"2025-10-17T23:31:06","slug":"plantar-fasciitis","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/plantar-fasciitis\/","title":{"raw":"Plantar Fasciitis","rendered":"Plantar Fasciitis"},"content":{"raw":"

Pl<\/strong>a<\/strong>ntar F<\/strong>a<\/strong>scia<\/strong><\/h3>\r\n \r\n\r\n[caption id=\"attachment_1728\" align=\"alignnone\" width=\"300\"]\"\"<\/a> Figure 1. Plantar fascia and plantar fasciitis (PF): (A) Frontal plane of the plantar fascia with its different types insertions; (B) Posterior insertion of plantar fascia in calcaneus.[\/caption]\r\n

Plantar Fasciitis<\/strong><\/h3>\r\nIrritation and inflammation of the plantar fascia, which is a thick, broad aponeurosis (or flat tendon) that extends along the bottom (or sole) of the foot supporting the arch.\u00a0 Aponeurosis and tendons are connective tissues that are composed largely of long fibrous collagen proteins. The plantar fascia originates at the medial tubercle of the calcaneus and then divides into 5 bands at the metatarsophalangeal joints (joints between metatarsals and proximal phalanges of toes) and extends forming fibrous flexor sheaths around tendons of flexor muscles of the toes (and located on the bottoms of the toes).\u00a0 The plantar fascia plays a role in walking acting like a spring and is estimated to carry a significant portion (~15%) of the body\u2019s load (weight) acting as a tension bridge.\r\n\r\n[caption id=\"attachment_1733\" align=\"alignnone\" width=\"300\"]\"Plantar<\/a> Plantar Aponeurosis[\/caption]\r\n

Risk Factors - Plantar Fasciitis<\/strong><\/h3>\r\nThere is a high incidence in runners, as well as athletes of many sports that involve running or jumping (e.g., tennis, soccer, aerobics, volleyball) and professions that involve walking.\u00a0 Incident rate is estimated to be 2-4 cases per 1000 people per year.\u00a0 Long periods of standing, as well as carrying excess weight are risk factors, as is exercising on hard floors, especially with bare feet.\u00a0 Bony heel spurs can be associated with plantar fasciitis, though many individuals have asymptomatic heel spurs.\r\n

Pathogenesis - Plantar Fasciitis<\/strong><\/h3>\r\nPlantar fasciitis is multifactorial and the definite cause is unclear, though it is associated with microtrauma due to excessive stretching or repetitive stressing of the plantar fascia.\u00a0 Repetitive microtraumas can lead to degeneration, in which the collagen and vasculature of the plantar fascia becomes disorganized and inflamed.\r\n

Signs and Symptoms - Plantar Fasciitis<\/strong><\/h3>\r\nPain is often felt first thing in the morning and is predominantly located on the plantar surface of the foot near to the calcaneus.\u00a0 Typically the pain then decreases with walking, but then increases throughout the day as activity or prolonged sitting occurs. There may be some stiffness and swelling.\u00a0 The individual may walk with a limp or on their toes to avoid pain.\r\n

Diagnostic Tests - Plantar Fasciitis<\/strong><\/h3>\r\nPain may be reported when plantar-anterior calcaneal tubercle is palpated, or during ankle or toe dorsiflexion (pointing toes).\u00a0 Other physical tests (such as the Windlass test) are often done to rule out Achilles tendonitis, bursitis, stress fractures, and other problems.\u00a0 Sometimes imaging (e.g., x-ray, ultrasound) is used to rule tumors or fractures, as well as locate or reveal any heel spurs which may have formed in response to abnormal stresses.\r\n\r\n\"The<\/a>\r\n\r\nThe effect of dorsiflexing the toes on arch height (A). The windlass mechanism (B).\r\n\r\n[caption id=\"attachment_1741\" align=\"alignnone\" width=\"300\"]\"Figure<\/a> Figure 2. (A) The plantar fascia and the longitudinal arch of the foot form a truss. (B) Dorsiflexion of the toes during the late stance phase of gait tensions the plantar fascia around the metatarsal heads leading to an increase in the height and stability of the longitudinal arch of the foot \u201cWindlass\u201d mechanism. Source: Reprinted from Latt L.D.; Jaffe, D.E.; Tang, Y. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020 [9] (SAGE Open access licensed under CC BY-NC-SA 4.0, no permission required).[\/caption]\r\n

Treatment - Plantar Fasciitis<\/strong><\/h3>\r\nTreatment often involves approximately PRICE (Protection, Rest, Icing, Compression and Elevation), possibly anti-inflammatories (e.g., NSAIDs) and usually involves a full recovery.\u00a0 Protection can involve taping, orthotics, and improved shoes.\u00a0 In some cases where degeneration of the fascia has occurred, techniques such as platelet rich plasma injections, extracorporeal shock-wave therapy (ESWT), surgery, and physical therapy (stretching and strengthening exercises) are recommended.\u00a0 Some individuals recover quickly whereas other individuals can take 6 weeks or longer.\r\n

Prevention - Plantar Fasciitis<\/strong><\/h3>\r\nRunning can create forces of 2-3 times an individual\u2019s body weight creating strain on the foot.\u00a0 It is therefore recommended that individuals wear shoes with adequate arch support and heel cushioning.\u00a0 Discarding old shoes and rotating shoes daily that are in good condition is advised.\u00a0 Stretching the plantar fascia and leg muscles as well as warm-ups before and after exercise is recommended.\r\n\r\n \r\n\r\nSummary\r\n