Plantar Fasciitis: What is REALLY Happening in Your Heel

What is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain. This condition is caused by small, microscopic tears in the plantar fascia. These tiny tears develop from repetitive stress on the fascia due to excess pull on the fascia. Like all injuries, these microscopic tears stimulate an inflammatory response in an attempt to heal the injury. Repeated walking causes continued stress on the injured plantar fascia, making it difficult for the body to hear.  After time, the fascia begins to wear down and unravel. This is called plantar fascia degeneration.  The initial phase of plantar fasciitis is inflammatory, involving pain, warmth and even some swelling. “Itis” stands for inflammation. The later stages of the condition are degenerative and the condition is called plantar fasciosis.”Osis” stands for degeneration. Degeneration refers to a deteriorating condition.

Understanding Plantar Fascia Degeneration

Collagen unraveling and fragmentation in chronic plantar fasciitisThe main component of the plantar fascia is collagen. Think of the collagen within the plantar fascia like a rope, being constantly stressed and eventually torn and frayed. The body initially responds to tearing with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the tear. Continued walking causes stress and further tearing, which limits the body’s ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. New blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia.

Microscopic representation of normal plantar fascia with collagen in parallel alignment. Microscopic representation of chronic plantar fasciitis with disordered and fragmented collagen.

The diagram above on the left is a graphic representation of what a healthy, normal plantar fascia looks like microscopically. The collagen is neatly organized and in parallel alignment. This parallel alignment creates strength. In the diagram to the right, note the disorganization of the collagen fibers. These collagen fibers have been laid down by fibroblasts quickly, in an attempt to repair the tearing and bridge the injury gap. The collagen is also unwinding and fragmenting. This creates a weakened and thickened structure.

Plantar Fascia Treatments

It’s important to recognize the chronic, degenerative stage of plantar fasciitis because the course of treatment may differ. Anti-inflammatory measures such as icing, anti-inflammatory medications and steroid injections may not be as successful treating the condition. The keys to long term treatment still include stretching, inserts and shoes, but also strengthening exercises. Exercises to help strengthen the arch will help decrease the pull and stress on the plantar fascia, which is one of the factors contributing to the re-injury process. Visit our website for more information on plantar fasciitis/fasciosis.




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