Before we can explain what Plantar Fasciitis is, it is helpful to know where it occurs; therefore we need to understand the anatomy of the foot.

There are a total of 26 bones in the foot. The toes contain 14 of these bones with three per toe, except the big toe, which only has two bones. These bones are arranged into three different arches which assist the foot in negotiating alterations in terrain. These arches are labeled as the transverse arch and the medial and lateral longitudinal arches.

The main arch associated with plantar fasciitis is the medial longitudinal arch located along the inside of the foot. The plantar fascia is a thick, wide ligament which attaches to the calcaneus (heel bone) and travels to the metatarsal heads (balls of the feet) and into the toes.

If the plantar fascia is placed under an increased amount of strain, the ligament begins to over-stretch and tear. If the foot is not weight-bearing for a prolonged period of time, such as while sleeping, the body begins to lay down scar tissue in order to try healing the tear. When the person stands up again, the plantar fascia begins to stretch and the newly formed scar tissue tears. This results in the notion that the first step out of bed in the morning is when the pain is at its worst.

There are two main methods for the plantar fascia to undergo an increase in tension. One situation that increases tension is weight gain. This may be due to inactivity, an increase in caloric intake, or pregnancy. The weight gain puts more strain on the bottom of the foot causing a stretch of the medial longitudinal arch. This results in over-stretching of the plantar fascia, leading to plantar fasciitis.

The second method of increasing plantar fascia tension is due to poor foot biomechanics. The proper gait cycle (walking pattern) has the outside of the heel striking the ground first. This is why it is normal for the outside of the heel to wear down first on footwear.

As we move forward, the weight should be distributed mainly along the outside of the foot. This should occur until the opposite leg swings forward, upon which the weight distribution should shift toward the inside of the foot (pronation), followed by pushing off with the middle of the big toe.

One of the most common problems discovered with foot biomechanics is the overpronation syndrome. This entails the person rolling over too much onto the inside of the foot. This puts excessive strain on the medial longitudinal arch and can cause tearing of the plantar fascia. This excessive strain on the inside of the foot can result in over-stretching of other ligaments in the foot leading to flat feet (pes planus). If this condition persists too long, a heel spur may form where the plantar fascia attaches to the heel.

To treat plantar fasciitis, it is best to decrease the weight gained if possible. If not, rolling a golf ball lightly under the foot will help to strip down the scar tissue. It is important to not press too hard on the golf ball in order to avoid bruising the foot. Having the foot adjusted by your chiropractic professional often helps with the symptoms as well.

The heel has two main directions in which it can move: diagonally forward or diagonally backward. Usually the heel moves backward due to tension from the Achilles tendon and from weight-bearing pressure. By adjusting the heel forward, it will relieve tension in the plantar fascia and can relieve symptoms.

If these methods do not seem to offer benefit, it may be necessary to have a pair of prescription orthotics made for your feet. These are custom-fit insoles which offer support to the feet to help ensure a proper gait cycle thereby reducing the amount of strain on the plantar fascia.