Is That Crushed Glass on the Floor? No, That’s Just My Plantar Fasciitis

Plantar fasciitis is a painful condition of the sole of the foot. Technically, plantar fasciitis means inflammation of the plantar facsia – the connective tissue on the sole that runs from the heel to the toes. Most of the time, pain is felt on the bottom of the heel. Sometimes there’s burning or a sharp pain in the arch. This area may feel stiff, too. The term“plantar fasciitis” just describes a symptom, and doesn’t imply a particular cause.

Sometimes the issue stems from a problem with the foot itself – how it is used, how it is shaped, or how it is supported. People with both flat feet and high arches can be affected. Shoes with poor arch support may contribute, as may long distance running, running on uneven surfaces, other forms of athletic strain, and standing for long periods of time. Weight gain is another contributing factor, as it puts more stress on the heel and arch.

I believe a majority of cases of plantar fasciitis involve strain of the calf muscles, which may occur through any of the mechanisms listed above. Strain of these muscles can lead to ongoing irritability and shortening of the affected muscle fibers. Because the strained area contracts (forming a “myofascial trigger point”), the shortening may make the entire length of the muscle taut, resulting in pulling at its attachment points on the sole, right where you feel it. Obviously, if the cause is a trigger point in the calf muscle, therapies that are directed at the feet may alleviate the effect of this tension on the sole, but won’t resolve the root of the problem.

If you have plantar fasciitis, regardless of the form of treatment you choose, I recommend thoroughly investigating and working on your calf (or, better yet, have someone else do it). There are a few calf muscles that can form trigger points which send pain to the sole, described below. If you click on the name of each muscle, you can see a diagram that shows the most common location of its trigger point (indicated with an X) and the potential pain pattern this it produces (shown as red shading).

• The soleus, a broad muscle covering much of the back of the calf (though largely covered by the gastrocnemius). A trigger point in the soleus on the Achilles tendon, a few inches above the back of the heel, and maybe slightly toward the inside of the leg (rather than directly at the back) can refer pain right to the underside of the heel.

• The gastrocnemius, the main visible muscle of the back of the calf. A trigger point in the widest, meatiest part of the back of the calf, usually a few inches below the knee crease, will usually cause pain in front of the heel.

• The tibialis posterior, which tends to form a trigger point a bit further down the calf, still closer to the knee than the foot. This trigger point usually refers pain to the Achilles tendon and the arch.

Try pressing firmly on every inch of the back of your calf, methodically moving from one point to the next. If you find a tender spot, press and hold the point for a minute or two using your thumbs. While pressing on a tender spot, you can also try slowly dropping your foot (point your toes) and then extending your foot up toward yourself, continuing back and forth, pointing and extending repeatedly. If you spend 15 or 20 minutes each day working on your calf, you’re likely to notice an improvement in the pain in your foot. If the pain improves dramatically and you haven’t done anything new to the sole, you can assume that the problem was caused entired by these muscles.

There are also a variety of tools you can use to get to your calf. Some are like foam-covered rolling pins, you can use to roll firmly up and down the calf. Others squeeze the calf. I like using a small, firm ball, such as a lacrosse ball. The leg can be laid on a chair or table with the ball under it, and the ball pressed or rolled over all the sore places.

Meanwhile, direct work on the inflamed area of the sole can also produce a rapid improvement. This can be done by pressing on a ball (again, I like a lacrosse ball, others prefer a golf ball or baseball), scraping firmly and repeatedl y over the affected area using a dull-edged tool (such as the edge of a ceramic Chinese soup spoon, of the rolled edge of a metal jar lid – a practice known as gua sha), or best yet, having someone give you a deep, firm foot massage.

Wishing you lightness on your feet,

Dr. Peter Borten