Modern medicine defines plantar fasciitis as a condition where repetitive stress applied to the plantar fascia, a thick fibrous band supporting the sole, leads to microtrauma and inflammation. However, when it leads to chronic pain, it is accompanied by far more complex pathophysiological changes beyond a simple inflammatory response. Although it begins with inflammation, it often progresses to plantar fasciosis, in which degenerative change predominates over inflammatory cells. This signifies an alteration in the tissue architecture itself, including the breakdown of collagen fibers, proliferation of fibroblasts, and an abnormal increase in angiogenesis. It is like an old rubber band losing its elasticity and becoming frayed. Such structural changes are closely linked to biomechanical imbalances of the foot. Flatfoot, pes cavus, being overweight, incorrect gait habits, and wearing uncomfortable shoes continuously place excessive load on the plantar fascia, repeating microtrauma and hindering recovery. From a neurological perspective as well, chronic pain is not simply a local issue. Continuous pain stimuli can alter how the brain processes pain, potentially causing central sensitization where pain is felt even from stimuli that should not normally hurt. This lowers the pain threshold and forms a vicious cycle that generates pain on its own even without an external trigger. Furthermore, from an endocrinological perspective, research indicates that a chronic inflammatory state may be related to systemic hormonal imbalance. Imbalances in the stress hormone cortisol, blood glucose regulation issues, and vitamin D deficiency can diminish the healing capacity of the plantar fascia and worsen inflammatory responses. In addition, sole pain may appear as an early symptom of autoimmune disease or rheumatic disease; thus, chronic pain is an important message signaling that we need to examine our overall systemic health beyond simply a hurting foot. Before pain becomes chronic, it is crucial to understand and approach these multifaceted causes in an integrative manner.
