Foot & Ankle
Quick Reference
The plantar fascia is a thick band of connective tissue that spans the sole of the foot, running from the medial calcaneal tubercle (the bottom of the heel bone) to the bases of the toes. It supports the medial longitudinal arch and plays a critical role in the windlass mechanism — the stiffening of the arch during push-off that allows efficient propulsion in gait and running.
Plantar fasciitis is an overuse injury characterized by degeneration at the insertion of the plantar fascia on the heel bone. The term 'fasciitis' implies active inflammation, but research suggests the condition is more accurately described as a fasciosis — a degenerative process without significant acute inflammation — particularly in chronic cases. This distinction matters because anti-inflammatory medications are less effective for a degenerative condition than for an acutely inflamed one.
The most distinctive feature of plantar fasciitis is heel pain that is worst with the first steps in the morning. This happens because during sleep, the plantar fascia contracts to a shorter resting length. When you first stand up and the fascia is suddenly loaded, it is stressed beyond its resting length before it has had a chance to warm up and adapt. After a few minutes of walking, the pain typically improves — only to return with prolonged standing or walking.
Plantar fasciitis is associated with reduced ankle dorsiflexion (the ability to flex the foot toward the shin), tight calf musculature (particularly the gastrocnemius and soleus), reduced intrinsic foot muscle strength, and sudden increases in standing or walking load. It's common in runners who increase mileage quickly, people who stand on hard floors for work, and those transitioning to minimal footwear without adequate preparation.
The strongest evidence supports: eccentric calf loading exercises, which reduce load on the plantar fascia by improving calf-complex strength and compliance; soft-tissue work to the calf, Achilles, and plantar fascia itself; and addressing ankle dorsiflexion restrictions. Simply stretching the plantar fascia helps with symptom management but doesn't address the load-capacity mismatch that's driving the condition. Most cases resolve within 6–12 months with consistent conservative management.
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