Plantar Fasciitis - The Truth

  The plantar fascia is a thick band of connective tissue running from the medial tubercle of the calcaneus to the base of the toes. It sits just beneath the skin on the sole of the foot and plays a crucial role in how we stand, walk, and load the body (Page, Frank and Lardner, 2010). It is not a muscle. It does not contract or relax like other tissues. But it does respond to mechanical load, tension, and joint position. It behaves like a passive stabiliser that reacts to external forces. Its primary role is to: Support the medial longitudinal arch Control elongation during foot strike Resist excessive flattening Store and release elastic energy during movement (Earls and Myers, 2017) When healthy, the plantar fascia provides a reliable combination of structure and spring. But when the system around it is not functioning efficiently, it becomes overloaded. Although it is designed to tolerate high levels of repetitive strain, it does have a threshold. Once that threshold is exceeded, symptoms can begin to surface. The Plantar Fascia’s Functional Role Think of the fascia as a tensional bridge between the heel and the toes. During gait, it helps absorb impact, maintain arch height, and guide force through the foot and into the rest of the kinetic chain (National Academy of Sports Medicine, 2020). It works alongside: The spring ligament The long and short plantar ligaments Deep foot stabilisers such as the adductor hallucis, quadratus plantae, and lumbricals This network allows the foot to behave like a springboard rather than a flat platform. Without it, the foot cannot generate enough rebound force for efficient gait or impact absorption. The plantar fascia, although passive, is heavily reliant on the coordination of these surrounding soft tissues. If these structures are underactive, weak, or poorly timed, the fascia becomes vulnerable to excessive strain. The plantar fascia is also rich in sensory receptors. This means it contributes to proprioception and helps the central nervous system understand how the foot is interacting with the ground. Any changes in its behaviour can impact balance, gait rhythm, and posture. The Windlass Mechanism The plantar fascia plays a key role in the windlass mechanism, a mechanical process that is essential to normal gait. As the heel lifts and the toes extend during terminal stance, the fascia winds around the metatarsal heads. This tension: Lifts the medial arch Stabilises the foot Converts the foot from a mobile adaptor into a rigid lever, ready for push-off The result is a more efficient propulsion phase and reduced muscular effort through the posterior chain (Hedrick, 1996). This mechanism relies heavily on adequate big toe extension, metatarsal alignment, and timing. If the fascia does not tighten properly due to restricted joint mobility, delayed muscle activation, or structural collapse, the foot fails to transition efficiently from load absorption to propulsion. In clinical terms, poor windlass function is often masked by overuse of the calf complex or compensatory strategies in the hip. Over time, this can contribute to strain at the plantar fascia as it takes on a role it was not designed to manage on its own. Structure vs Function Anatomically, the plantar fascia is made up of a central band and two smaller lateral bands, connecting to the medial, central, and lateral slips at the forefoot. The central band is the strongest and most involved in load transfer. The lateral bands contribute more to lateral foot stability and balance. While the anatomical structure is important, what matters most is how the fascia behaves under load. A healthy fascia should allow the arch to flatten slightly during weight acceptance and then recoil to assist in propulsion. This subtle give-and-return motion allows the foot to act as a shock absorber and spring. It is passive, but essential. It does not initiate movement, but it: Controls and distributes load Maintains the structural shape of the arch Supports postural adjustments and dynamic balance Influences timing and efficiency in gait Increased demand on the plantar fascia due to structural collapse or lack of muscular support can cause it to lose elasticity over time. This loss of recoil reduces energy return and can affect movement efficiency in walking, running, or standing tasks. It can also trigger neural guarding patterns that reduce mobility and increase global tension. The Bigger Picture: Regional Interdependence The plantar fascia does not work in isolation. It is part of an integrated system that connects the foot to the rest of the body. According to the Regional Interdependence (RI) model, dysfunction in one part of the body can lead to pain or reduced function in another seemingly unrelated area (Rath et al., 2016). In the context of the plantar fascia, this means: Limited hip mobility or core instability can increase compensatory loading through the foot Weak gluteal activation can alter foot strike mechanics and overload the medial arch Poor thoracic rotation can change gait rhythm and shift pressure through the lower limbs An old ankle sprain can cause altered loading through the opposite hip or sacroiliac joint Loss of big toe extension can show up as knee pain during stair climbing A rigid upper back can shift centre of gravity forward, increasing pressure through the forefoot Weakness in the deep neck flexors can result in postural shifts that change foot strike position Over-reliance on visual feedback for balance (common with vestibular dysfunction) can increase foot gripping patterns and disrupt normal gait mechanics These are not coincidences. They are connected patterns. The fascia may be where the pain shows up, but the root cause may lie elsewhere. The RI model encourages practitioners to move beyond the site of symptoms and investigate the body as a whole, integrated system. Why This Matters Understanding the plantar fascia's structure and role gives us a foundation. But real insight comes when we view it in context. The fascia is not the problem. It is the outcome. A messenger. A signpost that something else in the chain is no longer functioning efficiently. The foot is the only part of the body that interacts with the ground. The fascia is part of how we absorb load and return energy. If it is underperforming or overloaded, it tells us that the base of support is no longer supporting. This is where meaningful intervention begins, not with chasing the pain, but with understanding what the pain is trying to say. References Earls, J. and Myers, T. (2017) Fascial release for structural balance. Revised ed. Chichester: Lotus Publishing. Hedrick, A. (1996) 'The plantar fascia', Strength and Conditioning Journal, 18(5), pp. 7–10. National Academy of Sports Medicine (NASM). (2020) NASM essentials of corrective exercise training. 2nd ed. Edited by R. Fahmy. Burlington, MA: Jones & Bartlett Learning. Page, P., Frank, C. and Lardner, R. (2010) Assessment and treatment of muscle imbalance: The Janda approach. Champaign, IL: Human Kinetics. Rath,le. and Palmer, T. (2016) 'Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come', Journal of Manual & Manipulative Therapy, 24(6), pp. 285–288.