Plantar fasciitis means “inflammation of the fascia (connective tissue) of the bottom of the foot”. Newer research has identified this as an incorrect name as fascia does not have a vascular system, therefore, it cannot become inflamed. Some clinicians have suggested the name plantar fasciosis which references a degenerative condition of the connective tissue. To further complicate the condition, over the past few years, the term plantar fasciitis has become synonymous with any type of foot pain.
The plantar fascia is a dense, irregular connective tissue designed to protect underlying structures from the high amounts of force from standing, walking, running, or jumping performed during the course of a day. In addition to the underlying muscles, tendons, and ligaments, there are also plantar nerves which are the termination of the sciatic nerve. Through a variety of acute and chronic motions, these nerves can become irritated causing pain. In these cases, common recommendations such as rolling the foot on a golf ball or frozen water bottle can further irritate the nerves and worsen the pain.
Plantar fasciitis is often described by patients and clinicians as being difficult to treat. Physical therapists often recommend the golf ball or water bottle activity, stretching the calf, and strengthening the intrinsic muscles of the feet such as toe curls. Podiatrists often recommend cortisone injections, custom orthotics, and, more recently, extracorporeal shockwave therapy. Interestingly, while custom orthotics cost many times more than over the counter orthotics, both have the same long term outcomes.
Most patients continue to have symptoms after all of these interventions. This may be due to clinicians treating the symptoms rather than the cause. The majority of patients referred to our clinic, after a thorough evaluation of the patient, were identified as having foot pain due to lumbar radiculopathy, an irritation of one of the nerves of the low back that travels down the leg to the foot.
If you are being treated for plantar fasciitis or any other condition but not improving, it may be that the foot pain is a symptom of some other condition.