The causes of Plantar fasciitis or policeman’s foot as it is more commonly known, are many and varied. Indeed there are other conditions of the foot which can easily be mistaken for plantar fasciitis.
A common misconception is that plantar fasciitis is caused by heel spurs. Heel spurs may indeed be present but if anything, they are secondary to the plantar condition.
As a practitioner, I tend to put plantar fasciitis causes into two categories. Irritational and dysfunctional.
Irritational causes are those where there is often one particular extrinsic factor and the onset is fairly rapid, say over a period of a couple of days or weeks. The patient is very likely to be able to link their pain to a specific activity or cause.
Flip Flop style footwear
- Inappropriate footwear which does not support the arch of the foot or items like flip flops which cause the foot to operate incorrectly.
- Repeated or constant pressure to the fascia, such as standing on the rung of a ladder for long periods of time or when you are not used to it.
- Increasing running training too rapidly, on different terrain or changing techniques.
- New running or walking shoes which are not ‘worn in’.
- Injury to the underside of the foot. Even a day out digging in the garden without sturdy footwear can bruise and inflame the soft tissues of the underside of the foot.
- Standing or walking for long periods of time.
Some of these cases are not true plantar fasciitis, but merely short term damage and inflammation to the soft tissues under the foot.
In these instances, simply removing the cause and allowing the structures to repair is enough to rectify the problem. Conservative treatment may be required in some cases.
Dysfunctional causes tend to create long term pain and are linked to the body’s biomechanics. Their onset is usually slow, over a longer period of time. The sufferer tends to be unaware of a particular cause.
Foot of Charcot Marie Tooth disease patient by Benefros at en.wikipedia
- Diseases which cause deformation of the foot such as Charcot Marie Tooth Syndrome and neurological conditions.
- High or low medial arches.
- Incorrect foot biomechanics causing supination or pronation (weight being placed too far to the outside or inside of the foot).
- Arthritic conditions. (Most cases of plantar fasciitis are seen in the 40+ age group). Plantar fasciitis is indeed now considered to be degenerative in nature rather than inflammatory.
- Injury to the lower limb or spine.
- Being overweight, which places undue stress on the connective tissues and bones of the foot.
- Having tight achilles tendons or hamstrings, reducing flexibility of the leg and ankle.
These dysfunctional cases of plantar fasciitis tend to be more ‘deep seated’ and often require specialist treatment. In some cases, orthotics (specially designed insoles) are required to support the arch and distribute weight more evenly along the foot.