Plantar Fasciitis: A Major Pain in the Foot

What It Is, What Causes It and What You Can Do

By Drs. David Ryan, Thomas Lee and Heather Kight-Isaly

What is plantar fasciitis (PF)? In general, it refers to any foot pain that is associated with the bottom of your feet and involves irritation to any combination of the muscles, tendons, ligaments, but specifically to the area known as the plantar fascia - the connective tissue on the bottom of the foot that extends from the calcaneus (heel bone) to the back of the toes. As you might imagine, it's pretty easy to have problems with that area since you're standing, walking and/or running on it all the time. Let's take a closer look at the anatomy of the feet and see how plantar fasciitis (and other common foot conditions) can occur.

Foot Anatomy 101

The Bones: The bones of the foot include the five metatarsal bones, which make up the meat or thickest part of the area, and the phalanges or toes. The first toe is the largest and thickest, and it bears most of the weight and force. For example, when you propel yourself forward, the "big toe" bears most of the weight and provides most of the force to allow this movement to occur. Most of the tendons of the muscles also attach to the first toe. Now stop and think: When you run or walk, the majority of your body weight is on that one toe. Is it any wonder why you might have foot problems?

The rest of the bones generally provide stability. The bones of the foot are well-protected, but don't respond well to strong pulling or stretching forces, which is why most of the common injuries occur to the toes. The heel bone or calcaneus is the common site for plantar fasciitis. Other more common areas of pain surround the heel bone, but are more toward the toes.

The Ligaments: Holding all of these bones together are the ligaments. The most common reason for chronic pain in the foot is related to the ligaments and tendons. When these structures fail, it often leads to bones moving out of their normal position and wearing abnormally on other bones or soft tissue. Early detection of foot problems is a major factor in preventing more complicated conditions later. Simply trying to ignore the pain and hoping it goes away often leads to significant problems.

Tendons and ligaments can be mechanically strained/sprained, often resulting in a disruption to the local blood supply. Once the blood supply is interrupted, it further disrupts normal formation and repair of the collagen fibers in the ligaments and tendons. This weakens the entire area, and a chain reaction occurs: the adjacent fibers begin to take on the additional mechanical stress, and then are also injured. All of this eventually involves micro-tearing, swelling and nerve irritation.

Pain is the obvious result of this progression of mechanical breakdown and loss of blood supply. This cycle can expand progressively to other structures and lead to stress fractures, muscle strain, lymphodema, more pain, etc.

The Muscles: The muscles in the bottom of the foot are small, thin and easily injured. The most commonly associated is the flexor digitorum brevis (FDB) muscle. Other muscles are the abductor and adductor hallicus and the abductor digiti minimi. Any or all of these muscles may be involved with the mechanical breakdown of the plantar surface and hence the distribution of pain across the plantar fascia.

Treatment Options

Treatment of plantar fasciitis begins with the correct diagnosis. Depending on the intensity and duration of the condition, a single treatment approach or multiple approaches may be necessary. Many times the failure of PF treatments is directly related to the inappropriate treatment directed at something other than the true root cause of the problem. Here are a few of the possible treatment techniques your doctor may consider: