Why I Call Plantar Fasciitis the “Gateway Disorder”

I see between four and five patients per week with a “new” foot or ankle problem who suffered from plantar fasciitis at some point in their past. It might have been 15 years prior, 5 for others, and even more recently for some. They all have one thing in common: they had plantar fasciitis, and they got over it, and they now have a new foot or ankle problem.

I estimate that as much as 70 percent of the patients I see with foot or ankle problems, such as second MTP synovitis, PTT rupture/acquired flatfoot deformity, insertional Achilles tendinosis, midfoot arthritis, and more, come to me with a clear-cut history of plantar fasciitis in the past. Now, not all of those are my past patients, but some of them are…

When they were my past patients, they came to me, learned about daily calf stretching, and found long-sought-after relief when they implemented my recommended stretching protocol. Of course, they had tried MANY other treatments, which logically failed.

But now, they are visiting me for something new and completely different…

Instead, it might be second MTP synovitis. Or maybe it is midfoot arthritis. Or a posterior Tibialis tendon rupture. It might also be Achilles tendinitis. Or insertional Achilles tendinosis… The list goes on.

They may even say to me, “Doc, the problem I have today has nothing to do with the plantar fasciitis that they had in the past.”

But that’s where they are wrong!

The foot or ankle ailment they have today DOES, in the majority of these cases, have everything to do with their former plantar fasciitis.

The next obvious question is, "What exactly is the common denominator between foot or ankle problems they had in the past (plantar fasciitis to be exact) and the issue they have today?"

The common denominator is the cause: their tight calves, also known as equinus and isolated gastrocnemius contracture. To be more specific, my past patients' problem is that they QUIT their stretching protocol, understandably, after they found relief from their plantar fasciitis!

But my patients did not see the connection between the two until I pointed it out. Again, they might think the new problem is random or completely separate.

I tell them that the opposite is true: it has EVERYTHING to do with the same root cause, the equinus.

And that’s why you can think of plantar fasciitis as what I like to call the “gateway disorder,” in reference to the “gateway drug” phenomenon. What I explain to my patients is this: many of us have heard how the idea of “gateway drugs” is used to refer to certain drugs that lead to an increased risk of using stronger,  more dangerous drugs.

This is analogous to plantar fasciitis, because with a plantar fasciitis diagnosis—a result of calves that are too tight—we are more “at risk,” later, to develop other foot and ankle ailments that are also due to tight calves. Think of plantar fasciitis as a warning of what is to come.

Much like “gateway drugs,” plantar fasciitis (actually your tight calves) can lead to calf-related problems such as those mentioned. I have seen patients with as many as six calf related diagnoses occurring over years. This would be a typical scenario:

• plantar fasciitis at age 43

• second MTP synovitis followed by a second hammertoe at 56

• posterior tibialis tendon rupture and acquired flatfoot deformity or midfoot arthritis at 63

• insertional Achilles tendinosis at 74

Does this sound familiar? This is not random bad luck, or bad genes, or repeat injuries. It is due to the equinus that they never addressed or stopped addressing. Most importantly, it is entirely predictable.

Here is the point: these subsequent foot and ankle problems are preventable. 

Why Not Prevent These Problems…and Why Not Avoid Surgery?

What I’d like to shout out is that the larger idea is this: if you don’t want to have more problems and possibly surgery in the future, then simply stretch your calves. Or don’t because I know my colleagues would love your business.

If you currently have or have had plantar fasciitis, you have been forewarned! Take control and stretch your calves every day.