Plantar Fasciosis Explained

fasciitis-tearPlantar fasciosis is the degeneration (deterioration) of the plantar fascia as a result of repetitive stress. The plantar fascia is a broad, thick, fibrous band that extends from the base of the calcaneus (heel bone) to the base of the toes. The fascia is composed of a dense network of highly organized collagen fibers, which gives it the strength necessary to support the tremendous force placed through the arch when walking. During the push off or propulsive phase of walking, the plantar fascia tightens like a cable, increasing the arch height, shortening the foot and helping to create a rigid lever which increases the efficiency of motion as the body is propelled forward.Plantar Fascia Function

During this process, the section of the plantar fascia at the inside base of the heel is placed under the most tension. When excess force loads exceed the strength of the fascia, tearing occurs most commonly at this area. Small tears occur each time the fascia is placed under excess stress and the tearing resembles fraying of a rope. Microtears within the plantar fascia weaken the structural integrity of the tissue and increase the chance of further injury. The condition generally takes weeks to develop, but acute injuries and full fascial ruptures are possible under the right conditions.

As soon as the injury occurs, the body responds by increasing blood flow to the injured area, sending inflammatory cells and starting the healing process. The inflammatory process continues for about one week, but it can last much longer. The inflammatory process is overlapped by the reparative process. During the reparative phase, cells produce more collagen and the collagen is laid down in an unorganized fashion. The random configuration of collagen allows for bridging of the gap caused by the tear, but does not give the fascia it’s full strength. This phase generally lasts for 2-3 weeks, but can be prolonged and last for many more weeks. The last phase of the healing process is the remodeling phase. This phase can last for weeks to months and involves organization of the collagen fibers. The organization and alignment of the collagen fibers increase the strength and improves function of the plantar fascia.

When the injury occurs and the inflammatory process begins, plantar fasciitis is the most appropriate term for the condition. When the condition is diagnosed and treated immediately, the phases of healing progress and the condition heals within a few weeks. When the condition goes untreated and the plantar fascia is subject to repetitive injury, the inflammatory phase is prolonged and the reparative process is interrupted. This is a more common scenario as the initial microtears within the fascia may not cause much pain. Even when the condition becomes painful, it is difficult to minimize the stress on the plantar fascia because walking is a part of everyday life. Unless steps are taken to remove the aggravating factors which have contributed to the excess stress on the plantar fascia, the condition quickly worsens. The plantar fascia begins to deteriorate, which is represented by a disorganization and fragmentation of the collagen fibers and death of surrounding cellular tissue. The collagen fibers are separated by a myxoid substance, a semi-solid gel intermixed with waste products, which thickens the fascia, decreases cohesion between the fibers and further decreases it’s strength. The initial increase of oxygen, nutrients and cells to the injured area during the inflammatory process is replaced by a decrease in small blood vessels and a lack of oxygen, nutrients and growth factors.

As most cases of plantar fasciitis tend to progress in this fashion, plantar fasciosis has become a more appropriate term for this condition. Unfortunately, plantar fasciosis is much more difficult to treat when individuals fail to recognize the problem and seek treatment early.

More information on diagnosis and treatment of plantar fasciitis/fasciosis.

View our five part series on plantar fasciitis, plantar fasciosis and plantar fascia structure.

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20 Responses to “Plantar Fasciosis Explained”

  1. on 18 Nov 2009 at 9:24 pm Plantar Fasciitis

    That is a very good explanation of the condition. Is this blog your hobby or business site?

  2. on 14 Feb 2010 at 2:31 pm max williams

    I must agree. This the best explaination I have come across the web. Unfortunately I have had plantar fasciitis for about 5 years and after reading your explaination I would now call it plantar fasciosis as it has become chronical by every meaning.
    Through the last 5 years I have gone through every possible treatment and despite that I have not been able to get rid of it.
    Though I must admit that until today I have not really stick with a routine long enough. Only recentely I have got into a stetching routine and start to see some results. Now I am looking at the positive scenario and believe I will fight it off!

  3. on 02 Nov 2010 at 10:32 am patient

    If your situation is chronic, do yourself a favor and insist on a MRI. I wasted 2 years of my life dealing with a high profile sports doctor who sent me to PT and x-rays. In a desparate pain, I went to another doctor who sent me for MRI, which found a 6 mm tear in the plantar fascia. Needless to say, if I had a MRI sooner, the tear would likely have been smaller and the treatment easier. Now I am looking at severe treatment methods to relieve the pain and try to repair the damage. So much for a high profile sports doctor.

  4. on 21 Apr 2011 at 4:07 pm Craig

    Sorry to hear that patient. I’m in the same boat, too. I have had it for years. My last doctor treated me for a year I got no where. I went to a new doctor, and he wants to start all over again, cortisone, orthotics, etc. It’s frustrating. After reading your post, I’m going to insist on an MRI.

  5. on 08 Aug 2011 at 3:22 am Kathrene

    I am very desperate bcz I feel my life is ruined. I can’t work regular hours bcz I have enormous pain. My insurance won’t pay for an MRI. Now I have the pain in BOTH feet! I’ve gained 15 lbs from being inactive. For 2 months Ive been sleeping with night splints, use Shiatsu machine for massage, try stretching, just started going to Chiropractor but NO relief. I’m afraid I will loose my job, I can’t perform my regular housework or enjoy living a normal life. I watch people walking and I envy them!! I’m reluctant to have surgery which my doctor is pushing me to do bcz there are risks involved and not always successful. I don’t know what has the most success with this condition and what I should be doing to help heal both my feet now. Can this condition really be healed even if it’s severe?? I also have pain in my big toe and don’t know if this means I’m beyond repair now. Am I wrong seeing a Chiropractor vs. a PT? He used a sharp object under my foot and rubs it hard up and down. He says it will stretch the fascia? I will listen to anyone who can give me advice on what to do to heal this so I can feel like a functional human being once again and enjoy life. Thanks.

  6. on 01 Feb 2012 at 6:59 am Lynn

    I am a 50 yr. old female. I have a lump that has suddenly appeared on the bottom of my foot. It is right in the middle of the arch. It does not hurt yet. I am usually active but have been rather sedentary lately. The lump was not there in the afternoon but appeared about bedtime. It is about the size of a swollen Lima bean. It is not hard but thick. There is no discoloration. It is tender if I deep massage it. Can fatty tissue appear quickly like this? Should I go to the doctor. I don’t have medical insurance. I do go to a Indigent Care doctor’s office. I would probably qualify for medicaid if I needed medical care over and above a routine doc’s visit.

  7. on 29 Mar 2012 at 8:18 pm Maria

    I was diagnosed with plantar fascitis on my right foot almost two years ago. Tried the orthotics, but could not stand them! It was painful to keep them on more than two hours at a time. PT was short lived, and I didn’t have time to go to all of the appointments. Had three cortisone shots that only relieved the pain for two-to-three weeks, then my symptoms began again. Now the pain is in both feet! …. I just went to a new doctor yesterday and he gave me an ultrasound on both feet and quickly diagnosed me with ‘Plantar Fasciosis’. Started orthotripsy treatment in which electro-shock waves are given to your heal with a wand…sounds worse than it is. Painful…yes, but tolerable. I will keep you posted on my progress. FYI, my new doctor discussed with me that before he considers surgery he would try a new procedure in which he “power washes” the inside of my heel with a catheter (under anesthesia of couse), but he does not cut the fascia like a normal surgery would. Reading the above explanation, I’m thinking maybe he meant he would get rid of the maxoid substance (a semi-solid gel intermixed with waste products, which thickens the fascia, decreases cohesion between the fibers and further decreases it’s strength)….I will keep you posted on my progress. I hope for the best….for ALL of us!!

  8. on 06 Apr 2012 at 10:21 am tom scott

    hi,
    I’ve had this for getting on for three years now. I’m blaming the fact that I’ve to stand all day on concrete floors.
    Dr has tried injections into this area & steriods to the hips to try to minimise the pain to no avail.
    Trying ortmotic,but can only bear the pain for a short while.
    So now its rest (putting foot up)and the inactivity is driving me crazy.
    Next time I see the Dr I will ask for a MRI

  9. on 09 May 2012 at 5:57 pm julio herrera

    buenas tardes disculpe puede ayudarme tengo un dolor terrible en el talon y todo ocurre al estar de pie porque al caminar no tengo ninguna molestia me e ido donde barios doctores traumatologos y no me an ayudado en ningun centido gracias

  10. on 29 May 2012 at 12:21 pm Judy

    I have plantar fasciitis for two to three months now. I seen two podiatrists. The first did not say anything about what treatment I should do, the other told me to do A couple of stretches. Neither said anything as to what may be causing the problem- an essential element for any treatment for the problem. So I booked in with a physiotherapist. The Physio said my plantar was due to very tight calf muscles. He recommended some stretches and intra muscular stimulation (IMS). I have had IMS before for myofacial pain and it help “kick” the overly tight muscles to get loose.
    If you have extremely tight calf muscles and it is what is causing your plantar fasciitis, and you are doing your stretches but to avail then you may need your calf muscles “jabbed (IMS) into releasing.

    If your muscles are tight and knotted (trigger points) then it it these trigger points that must receive the IMS (the physio uses acupuncture needle to stimulate the muscle). If they are tight then it will hurt and you will feel your calf muscles jump (and when muscles in your foot will jump if the appropriate muscle has been hit by IMS). If the muscle is not tight and knotted it will not hurt. Note only a trained physiotherapist or doctor should do IMS for they must know physiology in order not to harm you.

    So if it is tight calf muscles causing your problem stretching may help only to a point. It will not help until you can get rid of the knotted muscles and trigger points.

    For more info on IMS look up iStop Gunn IMS. It will tell you more about the treatment.

    Judy

  11. on 20 Jun 2012 at 6:35 pm Frank C.

    Thank you for the detailed explanation. Some sites give an “explanation” which makes no sense, but this explanation makes sense.

    Here are a couple of factors which I think are worth considering:

    A) Vitamic C is supposed to speed healing of tissue in general, including plantar fascia. Some authorities stipulate ascorbic acid, instead of Ester C, meaning that it has to be taken every few hours. (I use powdered form, about 1/4 tsp combined with 1/8 tsp baking soda in a small amount of water until the acidity is neutralized, then add more water and drink it, every 3.5 hours.) But if you have heart disease, there’s a good chance it will cure it too (see The Pauling Therapy) when combined with Lysine. Dr. Owen Fonorow (not an MD) has developed supplements which are supposed to address a few types of cardiovascular disease. If you have a good physician who actually cares for you, get a diagnosis. But if you have a Nazi/witch doctor and you’re on the medical establishment’s kill-list, they might give you a bum steer into an early grave.

    B) Gait imbalance is supposedly a contributor to plantar fasciitis. (See Plantar Fasciitis for Massage Therapists http://www.thebodyworker.com/medrxplantarfasciitis.html .) After developing my fasciitis, I realized that the 5 mm heel lift which had been part of one of my orthotic inserts for years had flattened to nothing, so I got some vinyl lifts through GW Heel Lift, and they seem like they will never go flat. (The problem began shortly after I switched from old and probably hardened jogging shoes with a high heel lift to walking shoes with less heel lift and minimal heel padding, so the cure probably involves sufficient heel lift to reduce the need to lift the heel with the plantar fascia. Since I got four lifts from GW, I put two under one heel and one under the other, to approximate the higher heel lift of the old shoes.)

    C) My sister claims that she had plantar fasciitis, or something with similar symptoms, and that she cured it in a couple of weeks by eliminating nightshades from her diet. I eliminated them from my diet, and although I’m pretty sure that I’ve experienced some benefits (such as a reduced tendency to have headaches), my fasciitis is still with me. Interestingly, although many people have supposedly benefitted a lot by eliminating nightshades from their diet, I have yet to see anything at grocery stores which touts a lack of nightshades. It would seem that someone doesn’t want to bring the problem to our attention, and I’ve started noticing that the media seems to push tomatoes, which are a type of nightshade. I loved tomatoes, but I can live without them.

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  13. on 14 Aug 2012 at 10:39 am Marti

    My nightmare with plantar faciosis began 8 months ago and I have no idea what started it. I tried ice, exercises, stretches, cortisone injection, anti-inflammatory meds to no avail. A friend told me about a sports doctor who specializes in foot pain. When I met with her, she did an ultra sound on the fascia and found a lot of scar tissue that was keeping my feet from healing. She did a minimal invasive procedure called Tenex (FDA approved in 10/11) on both feet to break up and remove the scar tissue. Insurance covered it. I was back home in 2 hours. Full recovery takes 6 weeks. It has been almost 3 weeks for me. I am definitely better but still have tough days. The doctor said that is normal. Ultra sound shows the fascia is regenerating itself. I hope to put this behind me in another 3 weeks. I would recommend to anyone suffering from this horrible heel pain to check this out. It was the best option for me.

  14. on 17 Feb 2013 at 9:25 am Irene

    Martin where did you find a dr that does tenex that’s exactly what I need

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