What could be causing fasciosis, or tissue death in the plantar fascia?

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We have a very special guest this evening. If you are in the barefoot community then I am sure you know Daniel Howell , PhD , also known as The Barefoot Professor. Dr. Howell is a Professor of Biology at Liberty University due where he teaches human anatomy due and physiology. Dr. Howell has performed biomedical research at Duke University due Medical Center and McGill University in Montreal. He is a huge advocate due of barefoot living and is also the author of The Barefoot Book: 50 Great Reasons To Kick Off Your Shoes . Tonight he talks about how and why plantar fasciitis is widespread and how to relieve pain naturally.
What is plantar fasciitis? Plantar fasciitis is one of the most common foot injuries experienced by Americans. It’s been estimated that up to 30 million people may be afflicted with plantar fasciitis in the United States alone, and these people account for up to 40% of the visits to podiatrists. Why is plantar fasciitis so common? A cursory search online will provide due you with a litany of websites – many quite reputable – that parrot pretty much the same. Plantar fasciitis is described as “microtears in the plantar fascia [that] lead to collagen degeneration” reads one website and the condition is caused by “prolonged running, jumping, standing, or walking,” “gait abnormalities,” “obesity,” and “poorly fitting footwear.” Preventative measures include losing weight and wearing due footwear that is “well cushioned” with “ample arch support.” After perusing several websites with pretty much the same information one could be left feeling as if they truly know what plantar fasciitis is, what causes it, and perhaps the best course of treatment. And yet, next year over one million due people will see a doctor because of plantar fasciitis just as happened last year. And many of those cases are recurring. The sad reality is that people continue to suffer from plantar fasciitis because due all of those websites are wrong. I know that’s a bold assertion, but unfortunately almost everything we think we know about our feet (and shoes) is, in fact, wrong. As is typical, when it comes to Americans and their feet, many people – including due doctors and podiatrists – simply cannot imagine due the possibility due that their foot woes may be due to their shoes. Not a poor choice of shoes, but to SHOES. Nor can they conceive that the best thing they could do for their aching feet is simply to take off their shoes and just walk around barefoot a little. That advice is not given on any of the most popular medical websites I reviewed on plantar fasciitis. Fortunately there are podiatrists who are willing to question the status quo on plantar fasciitis. Drs. Harvey Lemont and Ray McClanahan , for instance. Lemont’s research suggests that plantar fasciitis is almost universally a misdiagnosis. He and his former student, Dr. McClanahan, seem convinced by his research (as am I) that the majority of cases of plantar fasciitis are actually plantar fasciosis. What’s the difference?  It’s a seemingly small change in the name, but it’s a major change in how you think about the cause and treatment of the pain. Fasciitis refers to inflammation, whereas fasciosis refers to necrosis, or death in the tissue. How you approach treating inflammation versus necrosis will be markedly different. So, if most people apparently have plantar fasciosis, what is the cause and cure for this condition?
What could be causing fasciosis, or tissue death in the plantar fascia?  Dr. McClanahan speculates (and I agree) that the primary cause is the shoes we wear, specifically shoes with arch supports, elevated heels, toe springs, and narrow toe boxes. Unfortunately, virtually every shoe on the market has these features, especially “athletic shoes.” How exactly these features cause plantar fasciosis is described beautifully in this video by Dr. McClanahan, but the short version goes like this: elevated heels, toe springs, narrow toe boxes, and arch supports immobilize the foot into an unnatural position such that the posterior tibial artery is pinched and blood flow to the plantar fascia is severely reduced (see figure above). Over time, this results in death of the tissue due and the pain associated with plantar fasciitis. What can you do to prevent or treat plantar due fasciosis?  The absurdly simple answer is… take off your shoes and walk. I did that and I haven’t had plantar fasciitis in over 7 years now. I strongly urge everyone to adopt