6 Possible Causes of Plantar Fasciitis: What the Research Shows
Medically reviewed by Devanshi Modi, PT, Cert. MDT, CMP — licensed physical therapist with over 15 years of clinical experience.
The plantar fascia is a band of connective tissue on the bottom of your foot. It starts at the heel bone and helps support the arch of your foot when you walk.[1] Pain in this tissue, usually near where it attaches to the heel, is called plantar fasciitis. Despite the "-itis" in the name (which usually means inflammation), the condition can involve both inflammation and degenerative (wear-and-tear) changes in the tissue.[1]
It typically causes pain on the inner part of the bottom of the heel, which can get worse after long periods of standing or walking.[1] The pain is usually most noticeable with the first steps in the morning or after a period of rest.[1] The spot where the fascia attaches to the inner heel is usually tender when pressed.[1] The pain usually comes on gradually, often after an increase in how much you stand, walk or run.[1]
A review of 51 studies looked at 104 possible risk factors for plantar fasciitis. Higher body weight was the only clinical factor with a consistent link, and the review found little evidence for common beliefs about foot and ankle mechanics.[2] All but one of those studies compared people with and without heel pain rather than following people over time, so they can show a link but cannot prove cause.[2] Below we look at six factors people often ask about and what the research shows for each.
1. Tight Calves and Limited Ankle Motion
A systematic review found some evidence that people with chronic heel pain have less upward bend at the ankle (ankle dorsiflexion).[3] The American Physical Therapy Association (APTA) clinical practice guideline for heel pain lists limited ankle dorsiflexion as a risk factor clinicians should check, and it recommends calf and plantar fascia stretching to help reduce heel pain.[1] The evidence is mixed, though: the larger review above found little evidence for common beliefs about foot and ankle mechanics,[2] so a tight calf or stiff ankle is best seen as one possible contributor rather than a proven cause.
2. Flat Feet or High Arches
The arch on the inner side of your foot is supported in part by the plantar fascia.[1] There is some evidence that flat feet and high arches spread pressure differently under the foot when you walk (for example, high-arched feet tend to have higher pressure under the heel), although foot shape explained only a small part of the differences.[4] The APTA guideline includes foot posture in a heel pain exam.[1] But a systematic review found the evidence linking foot posture to chronic heel pain inconclusive,[3] so having flat feet or high arches does not mean you will develop plantar fasciitis.
3. Higher Body Weight
Higher body weight is one of the most consistent findings in plantar fasciitis research. In a review of 51 studies, having a body mass index (BMI) above 27 was linked with about 3.7 times the odds of plantar fasciitis, and the link was strongest in people who are not athletes.[2] The APTA guideline also lists a high BMI in non-athletes as a risk factor.[1]
4. Running and Long Hours on Your Feet
Plantar fasciitis is one of the more common running injuries; in a review of studies in runners, it made up about 6% to 8% of running injuries.[5] The APTA guideline lists running and weight-bearing work, particularly where there is poor shock absorption, as risk factors.[1] Jobs that keep you standing or walking for long hours have also been linked with plantar fasciitis, although the quality of that evidence is low.[6]
5. The Hips and the Rest of the Leg
Whether tightness around the hip or thigh plays a part in plantar fasciitis has not been well studied, and the APTA guideline found too little evidence to say whether adding hamstring stretching to calf and plantar fascia stretching helps.[1] In our clinic, we look at the whole leg, including the hip and knee, when we assess heel pain; the APTA guideline notes that a broader lower-body screen can be done when a person's presentation calls for it.[1]
6. Footwear
There is little high-quality research on whether particular shoes, such as high heels or dress shoes, cause plantar fasciitis. The APTA guideline does suggest that care include advice on footwear options, but it rates this as based on theory rather than on clinical trials,[1] so it is still worth bringing the shoes you wear most to your evaluation.
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References
- Koc TA Jr, Bise CG, Neville C, et al. Heel pain - plantar fasciitis: revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303 · PubMed
- van Leeuwen KD, Rogers J, Winzenberg T, et al. Higher body mass index is associated with plantar fasciopathy/'plantar fasciitis': systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med. 2016;50(16):972-981. doi:10.1136/bjsports-2015-094695 · PubMed
- Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9(1-2):11-22. doi:10.1016/j.jsams.2006.02.004 · PubMed
- Buldt AK, Allan JJ, Landorf KB, et al. The relationship between foot posture and plantar pressure during walking in adults: a systematic review. Gait Posture. 2018;62:56-67. doi:10.1016/j.gaitpost.2018.02.026 · PubMed
- Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021;10(5):513-522. doi:10.1016/j.jshs.2021.04.001 · PubMed
- Waclawski ER, Beach J, Milne A, et al. Systematic review: plantar fasciitis and prolonged weight bearing. Occup Med (Lond). 2015;65(2):97-106. doi:10.1093/occmed/kqu177 · PubMed
This article is for general education and is not a substitute for an individual evaluation by a licensed clinician.
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This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider about your specific condition.