Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury.
Continued walking and other influencing factors causes further stress, which limits the body’s ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented.
At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation.
Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner.
The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.