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Mechanism and risk factors

Authoring team

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.

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