Plantar Fasciosis Explained
admin on Oct 26 2009 at 6:00 am | Filed under: Heel Pain & Fasciitis
Plantar 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.
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.
- Plantar Fasciosis Explained
- Strength of The Plantar Fascia
- Plantar Fascia Tear
- Breakdown of the Plantar Fascia
- Why do I Have Morning Heel Pain
That is a very good explanation of the condition. Is this blog your hobby or business site?
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!
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.
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.
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.
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.
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!!
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
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