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Common causes include: Overuse or repetitive strain (running, standing long hours) Flat feet or high arches Tight calf muscles Improper footwear Traditional treatments like rest, stretching, and orthotics can help but for chronic or stubborn cases, patients often need something more advanced to stimulate true healing

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Nevertheless, involvement of 5-HT 4 receptor stimulation is not the full story because data similar to those obtained with 5-HT 4 receptor agonists have been reported for treatment of the anastomotic site with brain-derived neurotropic factor in the recto-anal reflex model [81]