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Plantar Fasciitis and Thyroid Dysfunction

Plantar fasciitis is characterized by sharp heel pain that occurs on the first step in the morning or when getting up after periods of rest. Fasciitis is caused by microscopic tears in the plantar fascia, a long connective tissue structure in the bottom of the foot. Tearing of the fascial band leads to inflammation and eventual deterioration. The plantar fascia is composed of mostly collagen, but also elastin and long carbohydrate chains called glycosaminoglycans, or GAGs. The organized network of collagen adds to its strength, the elastin enables it to stretch and the GAGs attract water, improving resilience.

Musculoskeletal disorders often occur in association with thyroid disease, especially with hypothyroidism. Common musculoskeletal complaints in patients with hypothyroidism are muscle tenderness, generalized joint pain, cramps and weakness. Specific musculoskeletal disorders, such as adhesive capsulitis and carpal tunnel syndrome, have been linked to hypothyroidism. It has been theorized that hypothyroidism can cause plantar fasciitis for the same reason that other musculoskeletal conditions occur in hypothyroid patients. The disorders result from low thyroid levels that cause deposits in the connective tissue. Thyroid hormone inhibits fibroblast production and secretion of collagen, elastin and GAGs, all substances important in connective tissue structure. Low levels of thyroid hormone result in the overproduction of these substances, especially GAGs, which attract water.

Increased deposits of GAGs and the extra water increase the space between the collagen fibers. This disrupts the collagen network and compromises the integrity of the plantar fascia structure. The weakening of the plantar fascia increases the susceptibility to microscopic tears. Microscopic tearing occurs when the plantar fascia is placed under excessive stress. This often occurs with biomechanical conditions, but in a weakened plantar fascia can occur under normal conditions. The tearing results in inflammation and pain. Due to the early disorganization of the collagen network, the progression of plantar fasciitis, an inflammation resulting from tears, to plantar fasciosis, a degenerative condition, can occur more quickly. Plantar fasciosis is a more difficult condition to treat, which makes early diagnosis and treatment crucial.

Eliminating the stress on the plantar fascia is an important early treatment. This can be achieved by wearing supportive shoes and inserts and avoiding barefoot walking. Heel lifts, or shoes with a small heel, will also take stress off the arch. Heel cups may help relieve symptoms, but will not reduce the stress on the plantar fascia or improve the condition. Weight loss will decrease stress on the arch, unfortunately weight gain is common in patients with hypothyroidism and weight loss tends to be difficult. Stretching of both the calf and the arch are important in the healing process and specific stretching regimens should be initiated immediately after diagnosis. A night splint can facilitate healing and eliminate morning heel pain by stretching the plantar fascia throughout the night.

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