In the last blog (Plantar fasciitis- an overview), we covered the basics of plantar fasciitis. Now, let’s take a close look at some of the causes, as this understanding will help contribute to prevention, recovery, and overall foot and whole body health.
A direct cause of plantar fasciitis is unknown. However, there are several risk factors. Foot shape and mechanics (such as stability of the medial longitudinal arch, strength of forefoot muscles, limited ankle flexion, or an abnormal gait pattern) are all thought to be possible contributing factors in the development of plantar fasciitis (Cheung et al, 2016; Cole et al, 2005; Mayo Clinic, 2018). Though not specific to plantar fasciitis, improper shoe fitting, and the shape of the shoe not supporting the function of the foot, have been shown to impact foot health overall. In a literature review of 18 peer-reviewed articles, Buldt and Menz (2018) assert, “The available evidence indicates that a large proportion of the population (between 63 and 72%) are wearing inappropriately sized footwear based on length and width measurements, and that incorrect footwear fitting is significantly associated with foot pain, poorer overall foot health, corns and calluses in older people and foot ulceration in older people with diabetes.”
As a reflexologist, I can attest to this. Reflexology sessions start with a foot measurement and assessment, and the majority of people arriving to the office with foot pain are wearing shoes that are either the wrong length, the wrong width, or just are not built for helping the foot carry the body throughout daily activities. See “Five Tips For Healthy Shoes” for pointers for choosing good footwear.
People between the ages of 40 and 60 are most likely to develop plantar fasciitis, and people who are obese and/or are standing most of the day are also at risk as excess weight as well as repetitive strain from long periods of standing both have the potential to place extra stress on the plantar fascia (Mayo Clinic, 2018; Cole et al, 2005). High-impact exercises such as long-distance running, jumping, or certain types of dance can also contribute to earlier onset of plantar fasciitis (Mayo Clinic, 2018). However, taking care of your feet (and by extension your whole body) through reflexology, activity, and properly fitting footwear can support you in continuing to participate in activities you enjoy regardless of age, body type, or activity level.
It is also important to note that recent studies have been used to support the hypothesis that plantar fasciitis could more accurately be described as a “fasciosis” (degenerative process), rather than a “fasciitis” (inflammatory process). Cole et al (2005) describe several studies that examined evidence regarding inflammation as the cause of pain in clinically diagnosed plantar fasciitis. Studies have shown several signs of tissue stress such as thickening of the plantar fascia, increased activity of cells that are associated with wound healing, breakdown of collagen, and edema (swelling) due to micro tears in the fascia, but not consistently the classic clinical signs of inflammation: pain, heat, redness, swelling, and loss of function (Lemont et al, 2003).
At this point, you may be thinking, “Why does it matter what it’s called?! My foot hurts!” Here is why: distinguishing between tissue death and tissue inflammation helps determine the best way to proceed for those with plantar fasciitis and can also better inform prevention. In this video, Dr. Ray McClanahan provides a simple yet informative overview of the leading theories about how shoe shape contributes to plantar fasciitis.
The good news is that most people recover from plantar fasciitis (Mayo Clinic, 2018). In the final blog in this series, we will take a look at some options for dealing with plantar fasciitis. Until then, you can follow Mpath, LLC on Facebook and Instagram, or sign up for the newsletter list to stay informed of upcoming self-care reflexology workshops, new resources, special offers, and more.
Buldt, Andrew K and Hylton B. Menz. “Incorrectly fitted footwear, foot pain and foot disorders:
A systematic search and narrative review of the literature.” Journal of Foot and Ankle
Research, vol. 11, no. 43, 2018. https://doi.org/10.1186/s13047-018-0284-z. Accessed 12
Cheung, R.T.H. et al. “Intrinsic foot muscle volume in experienced runners with and without
chronic plantar fasciitis.” Journal of Science and Medicine in Sport, vol. 19, no. 9, 2016,
pp. 713-715. https://doi.org/10.1016/j.jsams.2015.11.004. Accessed 12 Nov. 2018.
Cole, Charles et al. “Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy.”
American Family Physician, vol. 72, no. 11, 2005, pp. 2237-2242,
https://www.ncbi.nlm.nih/gov/pubmed/16342847. Accessed 10 Oct. 2018.
Lemont, Harvey et al. “Plantar Fasciitis: A Degenerative Process (Fasciosis) Without
Inflammation.” Journal of the American Podiatric Medical Association, vol. 93, no. 3,
2003, pp. 234-237, https://www.ncbi.nlm.nih.gov/pubmed/12756315. Accessed 10 Oct.
“Plantar fasciitis.” Mayo Clinic, 7 March. 2018, https://www.mayoclinic.org/diseases-conditions/