Plantar Fasciitis: Fact vs. Fiction

In the modern world of reality television, exaggerated media headlines and fabricated statistics, deciphering truth from deception often seems to lead to even greater confusion. This is often true with medical conditions – where you are prone to read one thing on the internet, hear something different from your workout buddy and receive a third opinion from your neighbor whose aunt suffered from the same problem.

To provide clarity on some misconceptions about plantar fasciitis (and help you avoid a Google search on the condition, which may result in a headache), I am separating fact from fiction below:

FICTION: The plantar fascia is the sole muscle that supports the bottom of the foot.

FACT: The plantar fascia is an aponeurosis, or thick band of fibrous connective tissue, that joins and stabilizes muscles to other muscles or bones.

• While the plantar fascia, by nature of its attachment from the heel to the toes on the bottom of the foot, does provide arch support through tension during weight bearing, it is estimated to only contribute to 14 percent of necessary load bearing stability.¹ However, the plantar fascia does have a critical role in foot stability as it serves to stabilize the arch of the foot and allows the big toe to push off and lift the heel from the ground to enable walking. Thus, it is actually the big toe that bears the majority of weight during walking.² The plantar fascia also has a role in shock absorption.

FICTION: Plantar fasciitis only results from flat feet.

FACT: While research studies do confirm an association between foot pronation (flattening of the inner arch) and plantar fasciitis, a high arched foot is also a risk factor for development of plantar fasciitis.³

• Other validated risk factors include decreased dorsiflexion motion (inability to bring the toes toward the nose often seen with Achilles tightness), high body mass index, running, and occupations with a high standing duration (assembly line workers).³ Additional contributing factors including training imbalances, foot muscle weakness, or shoe wear may also predispose an individual to this condition.

FICTION: Orthotics should be used as the first treatment for individuals with plantar fasciitis.

FACT: While use of foot orthoses (either prefabricated or custom made) for plantar fasciitis can be an effective treatment option according to current evidence, it may not be necessary as part of the initial treatment.

• A short duration of antipronation taping, which is supported by research, often proves beneficial for symptomatic relief. Since favorable response to taping is predictive of those who may benefit from orthotics, it is a consideration for long-term management and prevention of recurrence. However, treatment often is effective and frequency and necessity of taping can be decreased or discontinued throughout the course of care. Therefore, following a course of care, orthotics may no longer be required or only needed during prior provocative weight bearing activity.

FICTION: Heel spurs cause plantar fasciitis.

FACT: Failure to treat plantar fasciitis may predispose heel spur development.

• Approximately 10 percent of the population have heel spurs. While 89 percent of patients who have plantar fasciitis also have a heel spur, there is no direct correlation with pain. In fact, 39 percent of individuals who have a heel spur are asymptomatic.^3,4  Additionally, removal of the heel spur is not necessary for successful resolution of symptomatic plantar fasciitis.

FICTION: Rolling a cold water bottle on the bottom of your foot is the best treatment for plantar fasciitis.

FACT: Since a variety of factors contribute to plantar fasciitis, there is not a sole best treatment strategy for all.

• Rolling a cold water bottle or ball along the plantar fascia is designed to mobilize and stretch the plantar fascia and in this regard is a well-supported method of treatment.³ Other methods for improving plantar fascia motility include foot and ankle mobilization, calf and foot massage, and calf stretching and have shown to be effective in resolving pain.³ Furthermore, use of night splints (which provide a prolonged stretch to the calf and plantar fascia during sleep) and tools such as Graston Technique® and ASTYM®, which are designed to break up fascial adhesions, are also beneficial treatments.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Plantar fascia. https://en.wikipedia.org/wiki/Plantar_fascia. Edited November 17, 2019. Accessed January 25, 2020.
2. https://www.healthline.com/human-body-maps/plantar-aponeurosis#1. Accessed January 25, 2020.
3. Martin RL, Davenport TE, Reischal SF, et. al. Heel Pain-Plantar Fascitiis: Revision 2014. Journal of Orthopaedic Sports Physical Therapy. 2014;44(11):A1-A23. doi:10.2519/jospt.2014.0303.
4. Johal KS, Milner SA. Plantar fasciitis and the calcaneal heel spur: Fact or Fiction? Foot and Ankle Surgery. 2012;18(1):39-41.