9 Not so Common Causes of Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is an injury to connective tissue on the bottom of the foot.  The plantar fascia (PF) runs from the inside side of the bottom of the heel, and extends down the length of the foot connecting to the toes.  The PF supports the arch of the foot, especially from just before your foot comes off the ground during walking. Inflammation of this tissue is called plantar fasciitis and most people typically have pain on the bottom of their foot and find the first steps of the day are extremely painful. 

Can you make this more technical for me?

Absolutely. As the foot lands on the ground, it goes through pronation(flattening of the foot) .  Pronation of the foot creates mobility in the foot, which allows the foot to adapt to the surface.  The arch lowers under the weight of the body and the tissues are loaded.  This loading function must very quickly transform into an exploding function (propulsion).  The foot is then transformed from a mobile structure to a stable structure by supination of the foot.  When the foot is in a supinated position, the foot is stable for propulsion.  The PF contributes to this stability.  If, in certain circumstances, the foot does not supinate, then the foot stability will be lacking.  Without the bony, capsular and muscular support to foot, the PF will be required to handle more stress.  The excessive strain that results can produce the clinical symptoms known as plantar fasciitis.   The most common consequence is a partial tearing of the PF from the heel.

Many (but not all) people experiencing plantar fasciitis have the “unlocked” foot because of failure of the foot to adequately supinate prior to the push off phase of walking.  The CAUSE may be anywhere in the body.

What are some of the not so common causes of plantar fasciitis?

ON YOUR LEG on the SAME SIDE – The suspects are those dysfunctions that allow excessive pronation (becoming flat footed) of the foot, or prevent the supination (more arch) of the foot.

  1. Lack of ankle joint bend – this means that your ankle is stiff and the limited mobility doesn’t allow it to work as it is designed, causing issues.
  2. Tight calf group – As the body moves forward over the foot, ankle bend occurs at the ankle and foot. (Normally supination reduces foot bend, but if the ankle does not have enough bend, then the foot may stay pronated in order to keep the foot bend available to the body.) This means that if you don’t stretch, your calf muscles get tight and your foot doesn’t work like it is supposed to.
  3. Weak butt muscles– When the foot goes through pronation, the entire buttock works to absorb the forces. These motions must be decelerated by the butt muscles. If they do not absorb the impact, the foot may go through excessive pronation, making sufficient supination for push off difficult to attain. This means that if your core is weak, you will notice it in other places, similar to how the alignment of your car can be off, yet you notice it by abnormal wear in the tires.

OPPOSITE LEG – In the opposite side leg, the causes are from things that prevent proper push off of that leg while you are walking.  Effective push off rotates the pelvis towards the front leg.  The pelvis rotation causes the front leg to rotate outward, assisting supination of the foot. 

  1. Lack of ankle bend or tight calf muscle group – poor ankle bend limits hip extension (backward movement). When the load prior to push off is decreased, then push off will be decreased. Less wind up means less force.
  2. Limited hip extension – The greatest power of push off comes from the hip flexor muscles. These muscles will be loaded by the motion of hip extension.  Without good hip extension, the push off will be less than optimal and the rotation of the pelvis towards the landing leg will be reduced.
  3. Painful or limited big toe extension – As the heel rises in response to the joint motions and muscle contractions of push off, the great toe goes through extension.  If this toe extension is limited, the power of the propulsion will be limited and pelvic rotation reduced.

Trunk/Core – In walking, and especially running, the abilities of the butt muscles of the landing leg depend on having a mobile, yet stable pelvis at the same time.  If the Core muscles are not lengthened and activated, the pelvis will not have mobile-stability, resulting in “functional” weakness of the same side hip muscles. If your butt isn’t strong, then you will have issues.

  1. Loss of upper back motion – Insufficient upper back motion can result in ineffective loading of the core muscles. Without the core taking some of the impact and load, pelvic mobile-stability is almost impossible.
  2. Weak abdominal muscles – If the upper back motion is available, that motion will be decelerated by the abdominals. The energy of deceleration must be transformed into concentric, motion-producing force. Failure of the abdominals to decelerate and/ or accelerate both the trunk and pelvis will negatively affect hip power.
  3. Neck Muscle fatigue/ tightness – As the trunk goes through motion in all three planes creating the load and explode of the core muscles, the neck is actually experiencing motion. With the head looking forward, the movement of the trunk creates bottom-up motion in the neck. If the neck muscles “tighten” with fatigue, either the head will have to rotate from side to side, or the head will remain steady by inhibiting the motion of the upper back.

Effectively catching the root cause is what sets the Physio team apart.  Without knowing the cause of plantar fasciitis, the permanent solution is less likely and the person will continue to chase the symptoms.  This is why finding good information on the internet is only the first step. If you would like to learn more about successful treatment strategies for plantar fasciitis, come to our FREE Plantar Fasciitis Workshop by either calling 828-348-1780 or click the image below to register online!

In the meantime, here are 3 quick tips you can do to help!

Chris Taylor is the Founding Physical Therapist at PHYSIO Physical Therapy and Wellness Asheville. He has been voted Best Physical Therapist in Western North Carolina every year by the Mountain XPress Reader Poll. His experience includes being a patient himself which deepens his understanding of each aspect of the rehab process. He has lived and worked in 11 states which contributes to the treatment style he has developed which breaks the mold. Become a better You today! #KeepAshevilleActive