Plantar fasciitis is one of the most common causes of heel pain and has been estimated to affect about two million people in the US, resulting in more than one million visits to both primary care physicians and foot specialists. Plantar fasciitis affects both sedentary and athletic people and is thought to result from chronic overload either from heredity, lifestyle or exercise. Current literature suggests that plantar fasciitis is more correctly termed fasciosis because it tends to be chronic rather than acute. Recent studies have posited the possibility of plantar fasciitis being chronically degenerative in nature rather than an inflammation. Treatment is often difficult because of the poorly understood mechanism by which the body heals chronic degeneration as opposed to acute inflammation.
The plantar fascia is fibrous tissue (neither tendon nor ligament) but rather is thought to be aponeurosis, a thin, sheet-like band connecting the heel to the metatarsals. Its main function is stabilizing and supporting the arch of the foot although it serves other functions related to gait. It can carry up to 14% of the total load of the foot depending on many factors such as ligament and tendon integrity. The plantar fascia is intrinsically connected to the Achilles tendon, especially in younger people which can explain why athletes with Plantar Fasciitis are more likely to present with Achilles Tendinitis and vice versa.
The plantar fascia is partially responsible for keeping the arch raised and springing the body forward during the propulsive phase of gait. Because of the hard surfaces that we walk on and the general population’s ever-increasing average weight, the Plantar Fascia is under more stress than ever to support our bodies. This combined with the fact that modern shoe construction has put more of an emphasis on style than form or function makes may account in part for the increase in plantar fasciitis cases.