When patients come to my Neuromuscular Therapy center outside of Boston with a complaint of plantar fasciitis pain, I assume they have been medically diagnosed and treated. After checking the medical and treatment history for their foot pain, I think about their symptoms and about possible sources for the onset and perpetuation of the pain pattern. I need to see their feet and check foot mechanics for evident stresses and distortion. Sometimes I check for leg length discrepancy which can change the gait and standing position of the feet.
Plantar fasciitis is inflammation of the connective tissue band that connects the heel to the toes on the bottom of the feet. It acts like a shock absorber. The major complaint is pain in the heel and often in the ball of the foot. The first steps in the morning can be excruciating. Pain usually goes away as the feet limber up but returns in the evening.
Causes are usually attributed to excessive stretching like from flat feet or from excess body weight, faulty foot mechanics like from high arches or Morton’s Foot Structure, activities with a sudden stretch of the arches of the foot like running and jumping, prolonged standing that tires the supporting muscles of the foot (especially on hard surfaces), walking with raised heels that shorten the calf muscles and achilles tendon, tightness in the calf muscles that causes Trigger Points to form that refer to the heel and foot, and weakness or chronic tension in the short muscles of the foot.
Since by the time someone comes to my center for treatment many of these factors have been addressed and treated, I go to my favorite subject: Trigger Points and muscle dysfunction. Pain in the heel often comes from the calf. (Refer to the previous series on Foot pain with tight calves. Foot pain from tight calves:Source/ and Foot pain with tight calves:Treatment/)
In the Case of Elsie M., her pain had it’s onset from dancing on a concrete floor. The second episode came after wearing high heeled boots and the most recent pain was from an aerobics class. Elsie’s foot mechanics were off too: high arches, Morton’s Foot and excessive tension in the short extensors of the toes of her left foot.
Plantar foot pain originating from the short muscles on the bottom of the foot is my major interest because they are right underneath the plantar fascia and have Trigger Points with exactly the same pattern as the pains of plantar fasciitis! Read the details in the next post on Plantar Fasciitis Treatment.