Podiatrist · Specialist in Biomechanics · Founder of VOLKAN
"When a person tells me that their heel hurts, I rarely think first of the plantar fascia. I think about why that tissue has reached the limit of its capacity."
There is a pain that completely changes how you start the day.
You get out of bed.
You place your first foot on the ground.
And a sharp pain appears right under the heel.
You take a few steps.
It seems to get better.
But after sitting for a while, it comes back.
If you have felt something similar, it's likely someone has told you that you have plantar fasciitis.
It is one of the most common diagnoses in consultation.
And, at the same time, one of the most simplified.
Because we tend to talk about fasciitis as if it were the problem.
When, in reality, it is almost always the consequence.
What biomechanics says
The plantar fascia is a band of connective tissue that connects the heel to the base of the toes.
Its function is not simply to support the arch of the foot.
It acts as an important stabilizer during walking.
Every time we walk, it stores and releases energy, helping the foot function as a flexible structure when landing and rigid when pushing off.
For years we have known that many of the so-called "fasciitis" do not show significant inflammation.
In numerous cases we are talking about a plantar fasciopathy, a degenerative process caused by a sustained overload.
The question, therefore, is not just why the fascia hurts.
The question is why it has started to bear more load than it can tolerate.
Why does it appear?
There is no single cause.
Plantar fasciitis is usually the result of several factors that accumulate.
A sudden increase in physical activity.
A change of footwear.
Many hours on your feet.
Ankle stiffness.
Deficit of strength in the muscles of the foot or leg.
Excess weight.
Changes in training methods.
Or certain biomechanical characteristics that make the fascia work harder than desirable.
Each person arrives at pain by a different path.
And that’s why there is no universal treatment.
What I see every day in consultation
As a podiatrist specializing in biomechanics, one of the first things I try to explain is that fasciitis does not usually appear overnight.
The pain does.
But the process had been developing for some time.
Many people remember the exact moment it started to hurt.
However, when we analyze their history, we find weeks or even months of small overloads that the foot had been compensating.
Until it could no longer do so.
That’s why simply treating the pain without understanding why it appeared often leads to relapses.
My goal is never to only relieve the fascia.
It is to discover what has changed in that person's biomechanics so that tissue has started to suffer.
The most common mistake
There is a tendency to look for a single culprit.
The footwear.
The weight.
The sport.
The age.
But plantar fasciitis rarely depends on a single factor.
In biomechanics, almost everything works like a sum.
When several pieces stop working efficiently, the fascia ends up bearing a load that it should not.
And that is when the pain appears.
What you can do
Do not ignore heel pain that recurs for weeks. The sooner the cause is identified, the better the results tend to be.
Avoid suddenly increasing the load if the foot is already experiencing discomfort.
Maintain good ankle mobility and work on the strength of the foot and calf muscles when indicated.
Do not copy treatments that have worked for other people. The cause may be completely different.
Consult with a podiatrist to perform a biomechanical assessment and determine which factors are overloading the plantar fascia.
Conclusion
Plantar fasciitis usually does not occur because the fascia is weak.
It occurs because it has been working for too long for which it no longer has sufficient capacity.
As a podiatrist, I try not to focus solely on the tissue that hurts.
I try to understand what has led that tissue to that situation.
Because treating pain is important.
But understanding why it appeared is often the best way to prevent it from coming back.