Why do you get plantar fasciitis?
Plantar fasciitis is an inflammation of a thing called the plantar fascia in the heel and arch of the feet. There are several risk factors that can play in together to cause damage to the tissue and pain to come on. When some or all of these risk factors come together in just the right (or wrong) mix, you can find you get heel pain today where yesterday you were OK. Sometimes you can identify the event, like a very long walk or a bad pair of shoes. Sometimes though, it is nothing particular – just the tiny straw that broke the camel’s back.
The contribution that each of the various risk factors contributes towards causing plantar fasciitis is different for each person. Common risk factors include:
- Foot structure
- Surfaces we stand on
- Activity level
As you get older, plantar fasciitis is much more common. The graph below shows roughly how common it is with increasing age. Plantar fasciitis is also a condition that occurs in episodes. As you get older, these episodes of plantar fasciitis become more frequent and increase in severity. This is due to changes in the collagen in your body. Collagen is the substance that gives connective tissue structures like the plantar fascia its strength, some of its stretch and its ability to bounce back. As you get older the collagen significantly changes, it becomes weaker, less stretchy and less bouncy. This change occurs in your mid-thirties and is the same reason why we develop wrinkles as we age.
You may have also noticed that as you have gotten older the arches in your feet have lowered. This occurs due to a combination of the change in collagen described that binds all the bones together less firmly, allowing them to ‘spread out’ a bit. As the arches lower, they also lengthen which causes the plantar fascia to be stretched over a longer distance, causing strain.
Our feet are designed to carry the weight of our body. Excess body weight puts extra stress through the bones, muscles and ligaments and creates more pressure that will push the arch down into a flattened position. The plantar fascia is the structure that has most of the job of resisting this flattening.
Women quite often experience plantar fasciitis during pregnancy. This is due to carrying the extra weight of a baby and the production of a hormone called ligament relaxing hormone. This is made towards the end of the pregnancy for the purpose of relaxing the ligaments around the pelvis in preparation for child birth. However, it doesn’t just affect the ligaments around the pelvis but also the ligaments in your whole body including the feet. This, coupled with being heavier than usual, causes your arches to flatten. They do not automatically return to their previous height which can cause the feet to remain flat thereafter. Wearing an orthotic support during the last half of each pregnancy can be protective of causing this ongoing foot problem.
A flat or pronated foot is longer than one with a high arch. Therefore, the plantar fascia of a flatter foot will be stretched over a longer distance than it is in a normal or high arched foot. This puts tension and an elongation / pull through the tissue of the fascia and through the bones that it attaches to. At these attachment points, inflammation can occur and this will cause pain, usually underneath the heel or in a longways stripe through the arch. Tight calves can also be a major factor in moving too much stress onto the plantar fascia.
Occupations that involve being on your feet all day, whether it be standing still or walking around, increase your likelihood of getting plantar fasciitis.
The types of surfaces that you stand, walk and run on can affect your feet. Hard surfaces especially concrete and tile floors will not compress when you walk on them. This leaves your body to absorb the shock of your feet hitting the ground internally, through your bones, ligaments and muscles. This is in contrast to standing or walking on carpet or grass where there is a slight compression of the surface underneath the foot.
Poor footwear choices can contribute to the likelihood of developing plantar fasciitis. Wearing absolutely flat shoes, including thongs and ballet flats, is the main culprit. Other footwear risk factors include the hardness of the sole of a shoe, an improper fit and how much support the shoe provides for your foot.
The beginning of plantar fasciitis is often associated with a change in physical activity level. This is usually either an increase in the amount of exercise or a change in the type of exercise. Sometimes, it is not actually exercising that may cause the pain. People with plantar fasciitis often complain of pain when pushing a heavy weight uphill, for example a shopping trolley up a ramp, and when walking on sand barefoot along the beach.
What to do next:
If you have plantar fasciitis, seek treatment from a podiatrist sooner rather than later as the condition can be harder to manage when it becomes chronic. At our Podiatrist Brisbane clinic, we can offer immediate pain relief as well as long term correction. It is anticipated that we can halve your pain level within an hour of your first treatment by using an inexpensive bracing technique to reduce the pull on the fascia. So, don’t delay, seek treatment for plantar fasciitis today.