Mechanism:
- repeated tensile and compressional stresses on the arched foot
- fascial anatomy focusing stress into narrow band of fibrocartilage
- cycles of tearing and healing Release of chemical mediators of inflammation, producing pain
- eventually, myxoid degeneration and weakening of the fascia
- a pronated, flat foot and rarely a spontaneous rupture
- painful scar tissue and calcification (spur formation)
Risk factors:
- being over 40 and overweight are the main risk factors. Other risk factors:
- sedentary lifestyle
- reduced ankle dorsiflexion
- hard surfaces
- flat shoes
- human leucocyte antigen (HLA) B27 associated spondyloarthropathies - this last association includes psoriatic and reactive arthritis and is commonly accompanied by bilateral plantar fasciitis, which confers a poorer prognosis for resolution
- evidence of an occupational link is sparse, and plantar fasciitis is not recognised as a work-related or industrial injury
Reference:
Schneider HP, Baca JM, Carpenter BB, et al. American College of Foot and Ankle Surgeons clinical consensus statement: diagnosis and treatment of adult acquired infracalcaneal heel pain. J Foot Ankle Surg. 2018 Mar-Apr;57(2):370-81.