Plantar fasciitis is one of the most common and persistent causes of foot pain, characterized by sharp, intense pain at the base of the heel. Many people with plantar fasciitis notice the pain is most severe in the morning or with the first few steps after resting. This condition impacts a wide range of people, from casual walkers to competitive athletes, and has a particularly high prevalence among runners, affecting nearly 10% of those who run regularly. For active individuals, this pain can not only interfere with performance but also limit day-to-day mobility.

For years, overpronation—when the foot rolls inward too much as it strikes the ground—has been widely cited as a primary cause of plantar fasciitis pain. Many people with this condition are advised to wear supportive shoes or orthotics to counteract overpronation. But while overpronation is a common feature in plantar fasciitis, it may only be part of the story. Other factors like calf tightness, reduced ankle mobility, glute weakness and the biomechanics of the foot’s windlass mechanism also play a role in how plantar fasciitis develops and persists. In this post, we’ll delve into what plantar fasciitis really is, what may cause it, and some modern perspectives on effective treatments to reduce pain and improve foot health.

The windlass mechanism is a crucial part of the foot’s biomechanics, supporting arch stability and efficient movement. It occurs when the plantar fascia—the thick band of tissue that runs along the sole of the foot—tightens as the toes extend upward, such as during push-off in walking or running. This tension pulls the arch up, creating a stable base and storing elastic energy that helps propel the body forward. However, if the plantar fascia is strained or overstressed, as in cases of plantar fasciitis, the windlass mechanism can become compromised. This not only reduces the foot’s ability to absorb shock and propel effectively but also causes pain with each step, particularly in the heel area. Understanding the windlass mechanism is key to appreciating how the plantar fascia functions and why issues with this tissue can lead to foot pain and functional limitations.

When a foot and ankle are in an overpronated posture, the plantar fascia is lengthened. This lengthening of the plantar fascia weakens the windlass mechanism, and overtime will cause irritation to the plantar fascia. While patients with a natural low arch and flat foot are more prone to overpronating, this foot and ankle posture does not exist in a vacuum. This overpronated foot posture can stem from structural deformities of the foot, mechanical tightness of the heel cord, and muscle weakness. Weakness of the glutes, IT band and Quads can cause more shock into the joints of the foot and ankle as well as contribute to an increase in pronation.

As a chiropractor there are many things that I can do to help patients who are experiencing pain due to heel cord tightness or muscle weakness. This includes: strengthening of the intrinsic foot and ankle musculature, Glute strengthening exercises, Instrument assisted soft tissue mobilization of the plantar fascia, chiropractic adjustment of the foot and ankle, cold laser therapy, Kinesiology Taping and more!

Additionally, studies show that increasing time spent barefoot, or even utilizing barefoot shoes, may help to decrease foot pain in many cases. This is because walking barefoot, or with minimal support, helps to strengthen the intrinsic muscles of the foot as well as the windlass mechanism. Furthermore, spending prolonged time in highly supportive shoes may interfere with our bodies natural ability to posture the foot correctly, which leads to weakening of the windlass mechanism and increase shock to the foot.

When explaining this to patients, I often get asked “Does this mean I should throw out all my running shoes?”, in reference to shoes such as Brooks, Hokas, and other supportive running shoes. My answer? No, there is absolutely a time and place for this style of shoe, such as running. I don’t recommend most patients were these shoes all day, every day, just when performing high impact activities. I recommend trying to where more minimal shoes while at work or around the house. If you are new to minimalist or barefoot shoes, I also recommend starting to wear them for a short time initially, and gradually increase the time and activity level you perform in them.

If you want to see how chiropractic can help with your foot and ankle pain, give me a call at (334) 917-2181 or book an appointment online at centerlinechiropracticllc.janeapp.com, or click the book online button below.

Sources:

Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train. 2004 Jan;39(1):77-82. PMID: 16558682; PMCID: PMC385265.

Reinstein, M., Weisman, A., & Masharawi, Y. (2024). Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial. Annals of Physical and Rehabilitation Medicine, 67(2), 101786. https://doi.org/10.1016/j.rehab.2023.101786