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A recent AO comment got me thinking, and that is always a dangerous thing. (Found in comments section Calf Stretching: Its the AO Way or the Highway, Kapil, 2022/03/10 at 9:30 pm)

The block to the right is most of my response. In summary, the comment/question was about over doing it as the cause of their recent onset of plantar fasciitis.
I know what you are thinking, “Really? There is no way one thing can cause multiple problems.” To make a point, how about tobacco smoking? It causes lung cancer, right? Correct, and that is what most people associate with smoking. However, it also causes emphysema, coronary artery disease that leads to heart attacks, cerebrovascular disease leading to stroke, peripheral vascular disease that can result in leg pain and worse, amputation, esophageal cancer, Burger’s disease, and a few more. Oh, and I forgot, bad breath.
“Plantar fasciitis is not some mystical ‘poof’ and now you got it- there is an underlying singular cause. However, most of my colleagues forgo the root cause thing and focus only on the end result. No wonder plantar fasciitis  treatment  fails so often. I’m just getting going and feeling better already and it is, after all, all about me.
Here’s a thought. Should one put all their effort into eradicating the smoke, or should they fight the fire? Only a fool would fight the smoke and ignore the fire. This also goes for plantar fasciitis (smoke) and equinus (fire). I am OK for doing things to address the plantar fasciitis to make oneself feel better, but do not ignore the equinus.”
“… [there is] a critical concept that everyone out there in the AO Nation must understand. This includes my halfwit colleagues. Take a look at my post on inflammation. While “doing too much” may have triggered your plantar fasciitis, it was only the straw that broke the camel’s back. Your plantar fasciitis was just waiting to get going because you have equinus (calves that are too tight) that developed over the past several years and your boost in activities took it over the edge, but DID NOT cause it.  I am widely published in this area. This, my friend, is the root cause of plantar fasciitis and 19 other foot and ankle non-traumatic acquired foot and ankle pathologies. And the equinus will be there until you stretch it out.
One final point. Interestingly, plantar fasciitis can and often resolve without addressing the equinus. It is a mystery, and I have theories not to be addressed here. But know this, unresolved equinus, based on my 40 years of heuristic experience, in time can and will more likely than not cause one or more of the other 19 foot and ankle non-traumatic acquired foot and ankle pathologies (see below). 65% of my patients presenting with one of these other foot and ankle non-traumatic acquired foot and ankle pathologies had a clear cut history of plantar fasciitis in the past 5-10 years give or take. So, there are many reasons to stretch.” yada, yada, yada.
Here is the list of the 20 foot and ankle non-traumatic acquired foot and ankle pathologies that equinus causes or contributes to in a major way:


  • General start up pain and stiffness, foot and ankle (this in not old age folks)
  • Plantar fasciitis
  • Sever’s disease
  • Shin splints
  • Posterior Tibialis Tendon Rupture(PTTR)-Acquired flatfoot deformity
  • Second MTP synovitis/plantar plate rupture which leads to hammer toe
  • Morton’s neuroma
  • Insertional Achilles tendinosis/Haglund’s deformity
  • Achilles tendinitis/tendinosis
  • Recurrent musculotendinous Achilles ruptures, medial head of gastrocnemius
  • Calf cramps at night/Charley horse
  • Midfoot osteoarthritis/midfoot collapse
  • Ankle arthritis/Anterior ankle spurs
  • Navicular stress fracture
  • Calcaneal stress fracture
  • Jones/Fifth MT stress fracture
  • Diabetic Charcot arthropathy
  • Diabetic malperforans ulcer formation
  • Metatarsal stress fractures (stretch for prevention and after healed)
  • Achilles tendon ruptures (traumatic, stretch for prevention and after healed)
So, the take away folks is if you have any one of these non-traumatic acquired foot and ankle pathologies you should consider calf stretching and keep stretching. Just sayin’.