Plantar fasciitis is mostly a reflection of overuse of the foot. This is termed "lifestyle disease" and is discussed in more detail in my blog post on Foot and Ankle Pain here (clickable link). 

Rarely, plantar fasciitis occurs as a symptom of underlying rheumatoid disease.

The foot is the shock absorber of the body. When walking, the mechanical stress on the foot is up to 4 times body weight; when running or jumping, that stress increases up to 7 times body weight. The accompanying image may remind of a bow and bowstring – the foot is a similarly spring-loaded structure. There are several rows of joints at the top of the bony arch, in order to allow the foot to flatten and recoil during walking. The space between the bony arch and the plantar fascia is filled with muscles, and this is where things become interesting.

The identical shock-absorbing mechanism of the foot has been present since at least 2 million years. Homo erectus and homo habilis are 2 examples. Evidence of the ancient origin of our foot mechanism is here (clickable link). Homo sapiens has only been around for approximately 10 - 15% of that time (300,000 years). The differences between Homo erectus / homo habilis and modern humans is that:

• Homo erectus was the same height, but adult weight was only 40-55 kg

• they were strong and fit – they were hunter-gatherers and needed to keep moving in order to find food

• they lived in a natural world with unven ground to walk upon, which maintained the flexibility of the Achilles tendon and other muscles

Any structural mechanism that has lasted 2 million years with minimal change is very successful.  The problem is the abrupt change in the lifestyle of the modern human.

• we commonly weigh in excess of 90 kg 

• we live a predominantly sedentary lifestyle, which has led to relatively weak feet unaccustomed to the normal daily stresses of walking longer distances

• at the same time the Achilles tendons have become tight, again from relative inactivity; tight Achilles tendons further amplify the mechanical loads placed on the feet when standing and walking

Please note that “heel spurs” commonly accompany plantar fasciitis, but the heel spurs are not the cause of pain! Heel spurs develop from prolonged overload and bony compensation – bone always tries to heal by creating more bone. They are often seen incidentally on x-rays in people who have never had plantar fasciitis. 

The cure of plantar fasciitisis simple, but not easy: to become more like the ancestors from whom we have inherited this foot mechanism. In other words, the cure is to stretch the Achilles, and become stronger and maybe lighter (if bodyweight is high). Unfortunately, this is an individual journey for the person suffering with plantar fasciitis. There is no passive method by which medically-trained professionals can give the patient a more flexible and stronger foot – this requires personal physical exertion to accomplish.

Treatment of Plantar Fasciitis (ranked from most to least effective according to scientific evidence):

• The best exercise for strengthening is standing calf raises, as shown here (clickable link). You do not need to go to a gym. It can be done at home, as explained by a physiotherapist here (clickable link). Scientific evidence here (clickable link).

• Plantar fasciitis stretching: specific stretches for the plantar fascia as demonstrated here (clickable link). Scientific evidence here(clickable link). Note that the evidence for strengthening is more recent compared wo the evidfence of stretching. Anyway, standing calf raises offer both strengthening and stretching.

• Night splints can work very well - they are a variation of stretching and are meant to be worn in bed during sleeping hours.  However they can be cumbersome to wear and therefore not popular to use. I have tried them myself and was unable to fall asleep wearing them - a finding common to many patients. Examples of night splints are here (clickable link).

• Soft surface under the foot whenever standing, in order to act as supplementary shock absorbers and offload the foot, for example silicone insoles here, skechers shoes here or crocs clogs here.

• Passive treatments: such as low-level laser therapy and shock wave therapy have some mild evidence, but should not be relied upon to be the main treatment. I personally used one of these in my first few years in Orthopaedic practice, and I saw first-hand how many patients kept coming back with recurrent plantar fasciitis.

Remember that the only wasy to increase strength of the muscles is by active means.

I would not recommend the following treatments that are commonly offered:

• Cortisone injections: this is a very painful injection, and cortisone doesn’t cure the problem – it only hides the problem. When the cortisone wears off, the problem can come back, often even worse. Repeat cortisone injections can affect general health, and more seriously can weaken the plantar fascia, occasionally leading to rupture. A ruptured plantar fascia cannot be reconstructed, and can lead to significant destabilisation of the medial arch, transfer of forces to the lateral foot, and persistent lateral foot pain

• Surgery to cut the plantar fascia – this can lead to significant destabilisation of the medial arch, transfer of forces to the lateral foot, and persistent lateral foot pain

• Any treatment modality to try to address the “heel spur” – the heel spur is not the cause of the pain

• Platelet Rich Plasma (PRP) injections: weak scientific evidence, and therefore not supported by most insurance companies; expensive and of dubious value. The main problem with this treatment is that it tries to reinforce that a passive treatment exists for plantar fasciitis, when in fact treatment is active.

• Stem Cell treatment – same reasons as for PRP above

I hope that this has been informative. The above information reflects much of the most up-to-date scientific evidence regarding plantar fasciitis.