Tried everything?
Maybe not yet. Plantar fasciitis can be stubborn, but many people with chronic foot pain have never even heard of the best treatment options.
last updated 72 days ago, Dec 30th, 2009
Save Yourself from
Plantar Fasciitis!
AN ADVANCED TUTORIAL FOR PATIENTS AND PROFESSIONALS
Plantar fasciitis explained and discussed in great detail, including every possible treatment option, and all supported by recent scientific research
by Paul Ingraham, Vancouver, Canada MORE
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
illustrations by Paul Ingraham,
Lindsay McGee
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
What works for plantar fasciitis? What doesn’t? And why? Soon you will be able to answer these questions confidently. This is a detailed tutorial about stubborn cases of plantar fasciitis for patients and professionals — more thorough and scientifically current than any other source, and also more readable and interesting. It reviews all the theories, myths and controversies about the nature of the beast, and presents all possible treatment options. Unlike many conditions that I write about, there are some excellent treatment options, known to be effective even with many difficult cases.
Plantar fasciitis is a common and often persistent injury afflicting runners, walkers and hikers, and nearly anyone who stands for a living — cashiers, for instance. It causes mainly foot arch pain and/or heel pain, and morning foot pain is a particularly distinctive symptom. Plantar fasciitis is not the same thing as heel spurs and flat feet, but they are related and often confused.
Severe cases of plantar fasciitis can virtually stop you in your tracks.
Most people recover from plantar fasciitis with a little rest, arch support, and stretching, but not everyone. This tutorial is mostly for you: the patient with nasty chronic plantar fasciitis that just won’t go away.
Attention physicians & therapists
This tutorial is written for both patients and professionals. It includes detailed analysis of recent research that you won’t find in any textbook, and the document is crafted to suit any skill level. For instance, user-friendly footnotes add an optional layer of detail. See my reading guide for professionals.
The plantar fasciitis misinformation explosion
In the years since I started treating and writing about plantar fasciitis, there has been an explosion of free information about it on the internet. Unfortunately, this has not resulted in patients or health care professionals being better informed!
A lot of the information that you can find out there is simply repetition of the same points of conventional wisdom, many of which are just wrong. Misconceptions about foot pain have been spread far and wide, thanks to the miracle of the internet!
Misconceptions about foot pain have been spread far and wide, thanks to the miracle of the internet!
Plantar fasciitis is famously stubborn. Although the basic formula for plantar fasciitis treatment is fairly effective for mild cases, some people face a much more challenging recovery. I have suffered from a challenging case of plantar fasciitis myself, and I have helped many of my own patients with persistent cases. So I know from both personal and professional experience that the prognosis isn’t always good!
Patients with severe and/or chronic plantar fasciitis face a challenge in finding good help
Plantar fasciitis is not well understood scientifically or biomechanically, and most health care professionals are not aware of the full range of treatment options.
Would a rub help?
If only! A foot rub is nice, and in fact it can help a little, but massage therapy is one of the least effective of the common therapies for plantar fasciitis.
The average physical therapist (physiotherapist, chiropractor, massage therapist) does not know what the latest research says, and simply cannot offer patients advanced troubleshooting. I have a modern sports injuries text on my shelf which offers even less advice than many of the inadequate articles on the internet!
In fact, many health professionals are not even aware of the basic formula for plantar fasciitis recovery, never mind advanced care options for severe and/or atypical cases.
General practitioners are not prepared to treat plantar fasciitis, or most musculoskeletal conditions.1 Podiatrists (foot doctors) — especially in North America, where the profession is focussed on surgical procedures — often give poor quality advice about chronic, inoperable conditions like plantar fasciitis. The occasional tough case of plantar fasciitis is simply not on their radar.
For most podiatrists, the occasional tough case of plantar fasciitis is simply not on their radar.
So where can you go for help? You’ve already arrived …
What would Adam & Jamie do? You know, if they were doctors?
How can you trust this information about plantar fasciitis?
I’m inspired by the MythBusters approach: I question everything and I have fun doing it. (No explosions, alas.) I assume that anything that sounds too good to be true probably is. I make no big promises, I do not claim to know the one true cause of anything, and I am not selling a treatment system or my own services. I say “I don’t know” when I don’t know and I say “I’m guessing” when I’m guessing. I actually read scientific journals, I clearly explain the science behind every key point (there are more than 70 footnotes here), and I link to the original sources so you can check them yourself. I hang out with doctors. I study harder than I ever did in school. Much harder.
Some of my favourite sources
I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.
I’ve worked hard to provide the best information about plantar fasciitis available anywhere — better researched and referenced than anything else you can find, highly readable, and even entertaining. Every issue is explained in a clear, friendly style that’s just like coming to my office and having a nice long conversation about it, where all your questions get answered.
If you’ve been struggling with a tough case of plantar fasciitis, I think this tutorial will feel like a “good find”!
What is plantar fasciitis?
Plantar fasciitis is a very common2 kind of tendinitis (sort of3), especially common in women during menopause, but instead of an inflamed tendon, it’s the plantar fascia of the foot that’s inflamed.
The plantar fascia (AKA the plantar aponeurosis) is a sheet of connective tissue, similar to a ligament or tendon, that stretches from the heel to toes, spanning the arch of the foot. Plantar fasciitis is an inflammation and thickening4 of the plantar fascia. The “itis” suffix means “inflammation.”
![[Diagram of the foot and plantar fascia to demonstrate the anatomy of plantar fasciitis]](/resources/images/bow-arch.gif)
Foot arch-ery
The arch of the foot functions like a bow (as in a bow and arrow), and the plantar fascia is like the string of the bow. The tension in the “bow string” holds the shape of the arch. But every time you step, the “bow string” stretches… and when stretched too hard and too often, it gets irritated, and then it’s like a bow shooting you in the foot!
Plantar fasciitis is basically caused by chronic irritation of the arch of the foot due to excessive strain.
If the arch of your foot is like a bow, think of the plantar fascia as the bow’s string. The plantar fascia, along with several muscles both in the foot and in the leg, supports the arch and makes it springy. Too springy, and the foot flattens right out, overstretching the plantar fascia. Not springy enough, and the plantar fascia absorbs too much weight too suddenly.
Either way, it starts to burn with the strain.
Other than the fact that it’s on the bottom of your foot and you step on it a lot, why is the plantar fascia vulnerable to strain? Why exactly? What happens?
Getting to the root of plantar fasciitis
Clever-sounding biomechanical explanations for plantar fasciitis are as common as plantar fasciitis itself.
Many therapists and articles on the internet will insist that you must treat the “root cause” of plantar fasciitis. It would certainly be a good idea — there’s no disputing that. Now, if only it were possible to identify the root cause!
Unfortunately, there are so many possible root causes of plantar fasciitis — probably several of them happening at the same time — that it is effectively impossible (or just extremely impractical) for therapists to make a confident biomechanical diagnosis. The biomechanics are simply too complicated, and the scientific literature is riddled with contradictions.
For instance …
Could it be heel spurs?
Bone spurs on the heel (aka heel spurs and calcaneal spurs) are common — about 20% of the population has an extra bit of bone (sort of5) growing on the front of the heel.6 They are routinely blamed for plantar fasciitis because it seems logical that having a bony outcropping on your heel would cause heel pain, for much the same reason that you wouldn’t want a rock in your shoe. Even more interesting, they are often found in people with plantar fasciitis.
Seems straightforward, right? Wrong.
Unfortunately for common sense, things just aren’t quite that simple. In fact, there are quite a few more people with bone spurs than there are people with plantar fasciitis, and there is good evidence that it’s not the spur that hurts but the plantar fascia itself or other soft-tissue structures around the spur.78 Surgically removing bone spurs does not necessarily relieve pain, for instance!9 (They also tend to grow back.)
It’s clear that spurs may be more painful and problematic when other tissue factors are present, but you those factors can and do also cause plantar fasciitis symptoms whether you have a heel spur or not — and heel spurs may be completely painless without those factors!
So, as tempting as it is, it turns out that you just can’t count on a nice straightforward connection between heel spurs and plantar fasciitis. This was reaffirmed once again in a 2007 study that concluded, “Overall, the presence of a calcaneal spur [was] not correlated with patient satisfaction and recurrences.”10
Unfortunately for common sense, a bone spur is not like a rock in your shoe.
Perhaps I have plantar fasciitis because of high arches …
Or too low. One therapist will blame high arches, and the next will say it’s flat feet that cause plantar fasciitis. And sometimes they seem to have trouble deciding whether a given foot has a flat arch or a high arch.11 Why are experts contradicting each other? Probably because both flat and high arches are likely causes of plantar fasciitis.121314
For years, I incorrectly told plantar fasciitis clients with high arches that they were exceptional, because (I thought) plantar fasciitis usually only afflicts the flat-footed. Now that I know better, it seems relatively obvious that the plantar fascia is also irritated by an excessively high arch. If the arch is high, it means that the arch-support system may not be springy enough, and absorbs too much force too quickly.
This is what I call the “Goldilocks” syndrome: the strong need the body has for things to be “just right” in between two extremes.
And now for another example of the Goldlilocks syndrome …
My physiotherapist said I’m a pronator
Pronating (rolling the foot inward) too much is routinely cited as a mechanical cause of plantar fasciitis. Personally, I think therapists just like to accuse their patients of “pronating” because it makes us sound like we know what we’re talking about.
The truth is that excessive supinating (rolling the foot outwards) is probably just as much of a problem15 — but that gets ignored. You never hear about supinating. It’s like the unwanted child of plantar fasciitis research.
Probably my calves are too tight
Could be. Tight calves are another classic plantar fasciitis scapegoat, and the gastrocnemius and soleus muscles (the big calf muscles) certainly can put a strain on the plantar fascia.16 This situation is typical for people with a leaning-forward “ski jumper” postural pattern. And of course it is a standard side-effect of wearing high-heeled shoes.
But hold on to your muscle tone, because it turns out that it’s amazingly difficult to even define “tight calves,” let alone blame them for plantar fasciitis. Why?
End of free introduction to this tutorial
Full access to the rest of this tutorial is available immediately for USD$1995. Click the “Buy Now” button to purchase access, and then continue reading this document immediately.
- Payment takes 2–3 minutes, and it’s easy and secure!DETAILS
No sign-up or password is required, and eBook delivery is instant. If you’re not satisfied, you get your money back … of course.
Is it safe to use my credit card on your website?
Yes! The store is digitally secure and safer than a bank machine. My store is managed by an excellent company, eSellerate, in Nebraska, with a superb support staff I’ve been working with for years now.
What does “secure” really mean?
The store uses a secure (SSL) server, which means that all information you send to the store is encrypted. Hackers don’t try to crack this kind of protection on individual transactions — it’s possible, but not worth their effort.
Why do you ask for personal contact information?
I have to — it’s required by law to prevent fraud. However, Big Brother is not watching my customer database, and I have no use for your personal information. If you want, just fill in fake contact information. People do it all the time! I do need a real email address, or you won’t get a receipt. For more information, see: Security, Privacy & Refund Policies.
- What do you get, exactly? It’s not a physical book! You buy online access to the tutorial for 90 days.DETAILS
You can also print it, or save it. The full plantar fasciitis tutorial is about 17,000 words in 31 sections — the length of a slim book.
What am I buying? Is there a physical book?
No, there is no actual book. I sell online access to pages on SaveYourself.ca, just as scientific journals sell access to their articles — this is known as a “document-access” business model. You buy the right to visit the tutorial online for 90 days. Until you pay, it’s impossible to get to. While you have access, you can read the tutorial online. To preserve your purchase, you can print the tutorial, or save it as a webarchive file (instructions available to customers).
I’d rather read a book. Will you be publishing a book?
Almost certainly, but not for a while yet. For now I prefer to sell access to webpages. They are simply a better product: cheaper to produce, update, and deliver.
Do I have to download anything? Is there a PDF?
No, there is no file to download and store. There are several issues with PDFs: they are hard to update, glitchy and unreliable, difficult for some beginners to use, and more. Tutorials in the form of webpages are the superior product.
- Buy more and save 50%! Buy an “eBoxed set” of all eight SaveYourself.ca eBooks for great savings.DETAILS
What is the “eBoxed” set, and how does it save you 50%?
An eBoxed set is a bundle of all eight eBooks about pain problems for sale on this website, ideal for professionals, keen patients and anyone who wants more for less. Purchased individually, they would run you about $160, but the set is only $79.50 — a savings of $80.
Benefits include the savings, a full-year subscription, and inexpensive renewal forever.
Want only 5 tutorials? No problem. Just let me know which ones you’d like.
| Company | Regeneration Training |
|---|---|
| Owner | Paul Ingraham |
| Location | 888 Pacific St Vancouver, Canada V6Z2S6 |
| Service | 778-968-0930 support@SaveYourself.ca |
| Guarantee | 100% money-back |
| Read More | company policies |
| webstore by eSellerate security by GeoTrust |  |
Here’s a sneak peak of the Table of Contents for the plantar fasciitis tutorial…
|
To get access to all 31 sections, purchase the tutorial for $19.95. You’ll receive the full version right away.
 90 days access print or save 100% money-back guarantee exhaustively researched constantly updated reader questions answered 17,000 words 31 sections 62 footnotes all myths & controversies all diagnostic issues all treatment options
|
Testimonials
Here are some of the nicest things that readers have said about my plantar fasciitis tutorial over the years. Thanks everyone!
I’ve been practicing in podiatry for 16 years and I have successfully treated thousands of cases of plantar fasciitis. The condition is often misunderstood, and there are a myriad of theories out there, but this tutorial is one of the best things I’ve read on the subject. It provides an excellent overview of the latest treatment and self-treatment options, and makes sure that patients know when to see a medical professional. The crucial point Paul makes that I would like to back up is that plantar fasciitis can be successfully treated, but often requires multiple therapies and persistence.
Mark Heard, Podiatrist D.App.Sci, M.A.Pod.A., Australia
Nicole Villen, cashier who was having trouble working
Steven Coombs, plantar fasciitis sufferer
Jan A., triathlete, Oregon
Janice Campbell, mother of five, enthusiastic recreational walker, Oregon
Andrew Hall, IT guy, Ithaca, NY
anonymous reader
One more special testimonial. In the Spring of 2009, I received an incredible endorsement from Jonathon Tomlinson, a GP in Hackney, East London, praising the whole website and every tutorial:
Dr. Jonathon Tomlinson, MBBS, DRCOG,MRCGP, MA, The Lawson Practice, London
High praise indeed! Thank you, Dr. Tomlinson — testimonials just don’t get much better than that.
What’s New In the Plantar Fasciitis Tutorial?
A basic version of this tutorial was first published in 2003 when I originally observed that many stubborn cases of plantar fasciitis could be cured by “power icing,” and I wanted to get that idea out into the world. The tutorial underwent a major upgrade in July of 2006, becoming what I still believe to be the best available single source of information on the subject. Numerous minor improvements have been made since then, and this record of changes was started on August 26, 2007.
Wednesday, December 30, 2009 — Three updates in response to reader requests, two minor and one major: (1) some comments on Graston Technique; (2) an answer to the question, “Are soft night splints good enough?”; and (3) a substantive new section, “Steroid injections are promising.” I also made a number of other minor corrections and improvements today — I can’t help noticing and fixing other things. Major updates are always accompanied by a bunch of little ones!
Friday, September 25, 2009 — The world of plantar fasciitis science moves slowly. However, here’s an interesting addition: “A new therapy: Intracorporeal pneumatic shock therapy (IPST).”
Wednesday, July 1, 2009 — Major bibliography update. The SaveYourself.ca bibliography has long been the largest of its kind. It contains an incredible amount of surprisingly readable information about musculoskeletal health science, and it is now possible for visitors to search and sort the bibliography with powerful new features. For instance, every source about plantar fasciitis referenced in this tutorial can now easily be displayed in a single search, with a variety of options. See the front page for the announcement of the new features, or visit the bibliography itself.
Wednesday, April 1, 2009 — The visual design of the site was upgraded over the past several days. Although this is not an update to the content of this tutorial, it is nevertheless a significant upgrade for all of them — like publishing new editions of books with better typesetting and layout. The new design is even cleaner and reader-friendly; it now looks that good in most web browsers; and pages load as much as 50% faster. Many under-the-hood improvements will make it much easier for me to improve tutorial content. The tutorials are now well-oiled machines of digital publishing goodness, vastly superior to the low-production values of most eBooks. More information about the upgrade is published on the front page.
Thursday, February 26, 2009 — Science update for the section “Fancy ultrasound: Extracorporeal Shockwave Therapy (ESWT).” You can also read the new information for free in the article, The ESWT Saga Continues.
Monday, November 17, 2008 — Minor addition of item to the list of “Don’t bother with …” treatments.
Thursday, August 14, 2008 — Today I made numerous minor corrections, and significantly upgraded and expanded the section “Several conditions that might get confused with plantar fasciitis” while I was researching possible causes of unusual heel pain in one of my patients. I learned some peculiar things about “fat pad syndrome,” which turns out to be almost completely unstudied and unexplained — another odd little musculoskeletal mystery.
Saturday, July 26, 2008 — Minor improvements to icing and contrasting prescriptions, and added a case study story.
Sunday, June 1, 2008 — Added a couple references and made a number of minor clarifications and corrections based on reader feedback. Thanks, everyone!
Thursday, March 13, 2008 — Started upgrading the footnoting method today, with minor content improvements as well. Until now, the plantar fasciitis tutorial was the only major article left on SaveYourself.ca that didn’t use “dynamic” citations that link to the bibliography. It’s taken literally years to implement that system, and this is the final tutorial to upgrade! At long last! It won’t mean much to anyone else, but it’s quite a milestone for me.
Saturday, January 19, 2008 — Added the section “Super ultrasound: Extracorporeal Shockwave Therapy (ESWT).”
Sunday, December 23, 2007 — Added the section “Ultrasound and “Sonic Relief™” are options … with strong caveats.” I review the Sonic Relief™ product for plantar fasciitis, and reveal some interesting statements from the company’s medical officer. Note that this tutorial has now been upgraded three weekends in a row! And it was good before that!
Saturday, December 15, 2007 — Added the section “Using technology to confirm a plantar fasciitis diagnosis,” and updated evidence about night splints in the “Know your stretches” section. All of this new material is summarized for free in the short article, Thickened plantar fascia — really thick!
Saturday, December 8, 2007 — Revised and expanded the introductory sections, and upgraded the sections about massaging and trigger points to be more thorough. Added reference to recent research evidence that the plantar fascia is thicker in plantar fasciitis patients.
Sunday, August 26, 2007 — Upgraded the orthotics section (see “Get some arch support”) with two new footnotes and some more detail and clarity.
Further Reading
If you found this tutorial useful, you may also be interested in some other articles I’ve published:
- SYSave Yourself from Trigger Points & Myofascial Pain Syndrome! — Trigger points (also known as muscle knots) and myofascial pain syndrome, explained and discussed in great detail, including every imaginable self-treatment and therapy option for difficult cases
- SYThe Trouble with Orthotics — A consumer’s guide to choosing a supplier of orthotics
- SYMassage Therapy for Tired Feet (and Plantar Fasciitis!) — Perfect Spot No. 10, in the arch muscles of the foot
- SYIcing for Injuries and Tendinitis — Become a cryotherapy master
Other interesting reading:
- If this tutorial doesn’t quench your thirst for plantar fasciitis information, here’s one that might: HeelSpurs.com presents a truly gigantic article — several times the size of this one, if you can believe it, really more of an actual full-length book that just happens to be published online — billed as “the most extensive document on heel pain, plantar fasciitis, and heel spurs that is available.” I have no doubt that is in fact true, and the quality of the information seems generally good, or at any rate better than the average. However, there are several problems: it hasn’t been updated since 2004, the author’s credentials are poor, the writing is a bit awkward, the website is ugly (text cramped and hard to read), there are no footnotes whatsoever. Still, the author is well-informed, and it so thorough that it’s worth reading if you really want to know everything you possibly can.
Acknowledgements
This document and all of SaveYourself.ca was, for many years, created in my so-called “spare time” and with a lot of assistance from family and friends. Undying thanks to my wife, Kimberly, for countless indulgences large and small, and for being my “editor girlfriend”; to my parents for (possibly blind) faith in me, and much copyediting; and to Mike Gobbi, buddy and digital mentor, for many of the nifty features of this document (hidden and obvious). And thanks to all of the above, and many others, for many (many) answers to “what do you think of this?” emails.
Thanks finally to every reader, client, customer, and big tipper for your curiosity, your faith, and your feedback and suggestions and stores. Without you, all of this would be pointless.
And a few thanks to some health professionals who have been particularly inspiring to me: Dr. Steven Novella, Sam Homola, DC, Dr. Harriet Hall, Simon Singh, and Dr. Stephen Barrett.
Notes
Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”
Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.
More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
Return to text.- Chandler et al. Sports Med. 1993. Chandler and Kibler report a 10% occurrence rate of plantar fasciitis in runners. Return to text.
- The familiar term “tendinitis” is used here for simplicity and because the general principles of treating tendinitis (i.e. icing) probably still apply. Technically, plantar fasciitis should be compared to tendinopathy or tendinosis, because the tissue is not actually inflamed, but instead it shows signs of collagen degeneration. This was explained and supported well by Khan. The degeneration is “similar to the chronic necrosis of tendinosis, which features loss of collagen continuity, increases in ground substance (matrix of connective tissue) and vascularity, and the presence of fibroblasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis” (see Young). These findings are consistent with scientific papers written as recently as 2008, in which Andres et al write, “Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions.”Return to text.
- Karabay et al. Journal of Foot & Ankle Surgery. 2007. These researchers used ultrasonography to show that people with plantar fasciitis have thickened connective tissue on the bottom of their feet. The results were clear and unambiguous — a rare bit of clarity in a murky subject! See Thickened plantar fascia — really thick! for more information. Return to text.
- Technically it’s a calcification of the plantar fascia, not actual “bone.” It’s hard and brittle, but it’s also thin and relatively insubstantial. It’s not much more like bone than tinfoil is like a sheet of steel. Return to text.
- Barrett et al. Journal of Foot & Ankle Surgery. 1995. This study found that 21% of 200 random selected Americans had heel bone spurs. Return to text.
- Osborne et al. Journal of Science & Medicine in Sport. 2006. From the abstract: “ ... the key radiological features that differentiate the groups were not spurs but rather changes in the soft tissues.” Return to text.
- Tountas et al. Clinical Orthopaedics & Related Research. 1996. This paper reports on a study of twenty patients in the years after surgical removal of bone spurs. Although most of the patients had "excellent" or "good" results about three years later, their spurs had often reformed, and analysis of the soft tissues showed that “changes within the fascia, rather than the spur, are primarily responsible for the pathogenesis of the syndrome.” Return to text.
- Onwuanyi. Foot. 2000. From the abstract: “Calcaneal spurs cause plantar heel pad pain, but the roles of other co-morbid factors are significant. The excision of these spurs does not necessarily abolish pain.” Return to text.
- Beyzadeoglu et al. Acta Orthop Traumatol Turc. 2007. Return to text.
- That sounds strange, but it’s true. It’s pretty common for people to come into my office with so-called “flat” feet, convinced by a previous therapist that they have no arch left, when in fact I can still easily get my finger under their arch up to the first knuckle — something that you simply can’t do on someone who really has flat feet. Similarly, though not so common, I have often seen people accused by another professional of having high arches, when in fact they look nothing like it to me. So take such diagnoses with a grain of salt. Return to text.
- Huang et al. Chang Gung J Med. 2004. From the abstract: “There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.” Return to text.
- Kwong et al. Clin Sports Med. 1988. This is an expert opinion paper — not original research — which simply states that excessive pronation in the foot (part and parcel of having flat feet), is "is the most common mechanical cause of structural strain resulting in plantar fasciitis." This is debatable. The relevance of the reference is simply to demonstrate the diversity of opinion on the subject. It may well be that pronation and/or flat feet is the most common cause of plantar fasciitis, but it is certainly not the only mechanical factor that does so. Return to text.
- Bolgla et al. Journal of Athletic Training. 2004. From the article: “A review of the literature reveals that a person displaying either a lower- or higher-arched foot can experience plantar fasciitis. Patients with lower arches have conditions resulting from too much motion, whereas patients with higher arches have conditions resulting from too little motion.” Return to text.
- Hertling et al. Management of Common Musculoskeletal Disorders. 1996. p434. “Functionally abnormal supination is a failure of the foot to pronate, resulting in a foot unable to compensate normally. There is prolonged supination during the stance phase and a delayed pronation during the gait cycle. Stress fractures, metatarsalgia, plantar fasciitis, and Achilles tendinitis are common in this type of foot.” Return to text.
- Cheung et al. Clin Biomech (Bristol, Avon). 2006. From the abstract: “Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia.” Return to text.
