A Deep Pain in Your Sole,
by Bruce Schaefer, LMT
Copyright 2011, Bruce W. Schaefer
Prologue
You wake up one morning, after the blissful respite of nighttime. Looking forward to the endless possibilities that dawn brings, you take your first steps into the new day. As you head for the curtain to gaze upon the rising sun (or veer toward the coffee maker for a sip of that elixir of life), your morning ritual is shattered as a mysterious sensation of pain emanates from your foot. You can't recall anything you might have done that would cause such an injury -- a slip, a fall, stepping on a rock? You limp through your morning routine and soon forget about this puzzlement. An hour or two before lunch, you get up from your desk and are stunned by the return of this mystery pain. Limping toward the water cooler, you mull over all the possibilities of what this is or what caused it (and more importantly, what to do about it).
Plantar Fasciitis -- Tormentor of Soles
Sandwiched between the skin and the muscles of the plantar surface (the sole) of your foot is a thick band of fibrous connective tissue called the plantar fascia. The plantar fascia originates near the bottom of your heel bone then spreads forward to attach near the bottom surfaces of the bones at the base of your toes. The plantar fascia is an important element for supporting the arch of your foot.
If your plantar fascia experiences overuse or stress, its fibers may start microtearing and fraying. This condition, which may evolve into foot pain (and possibly inflammation), is known as plantar fasciitis. Symptoms of plantar fasciitis include:
- pain in the front, bottom portion of the heel bone and/or deep in the arch of the foot (with no known injury or trauma)
- intense pain for the first few steps after getting up in the morning and/or after long periods of sitting, then the pain subsides or disappears
- pain from climbing stairs, or prolonged standing, walking, or running
- pain is relieved with rest.
Symptoms of plantar fasciitis may have a slow onset and can occur in one or both of your feet.
Although heel pain is most often diagnosed as plantar fasciitis, there are other conditions which can cause pain in your heel, such as a contusion of the fat pad covering your heel bone or a stress fracture of the heel bone itself. Tarsal tunnel syndrome can cause sharp pain and numbness or tingling (not a symptom of plantar fasciitis) in the foot's arch, heel, and toes.
The Vulnerable Ones
Anyone can develop plantar fasciitis. However, those who are at the highest risk of developing this condition are:
- people with high-arched feet (or excessive pronation of the feet)
- people with jobs that require prolonged standing or walking
- runners (and other very active athletes)
- people that have started a new activity that suddenly puts a lot of stress on their feet
- people over 40 years of age
- people who are overweight (or have experienced recent weight gain, e.g., pregnancy).
Other factors can increase your likelihood of developing plantar fasciitis. Excessively tight calf muscles (and even tight hamstrings) can generate tension that travels down through your Achilles tendon and under your heel, putting excessive stress on your plantar fascia (which may cause its fibers to start microtearing and fraying).
Those Knotty Accomplices
Silently lurking within the muscles of your legs, myofascial trigger points could be making mischief. A myofascial trigger point is a nodule (a "knot") that has developed in muscle tissue, usually as a result of overuse during repetitive movement patterns (from work, sports, or other regular activities), postural patterns, or traumatic injury. In addition to being very tender or painful when compressed, a trigger point can cause the affected muscle fibers to shorten thus generating tension. Trigger point-afflicted muscles with fascial connections to the plantar fascia can put undue stress on your plantar fascia.
Another (much stranger) effect of myofascial triggers points is their ability to cause pain in another part of the body, often distant from the actual trigger point itself. This is known as "referred pain." Trigger points in certain muscles can refer pain to the sole of your foot and mimic plantar fasciitis pain.
What's a Poor Sole to Do
There are a number of things you can do if you suspect you are developing plantar fasciitis:
- Avoid activities that bring about or worsen your symptoms.
- Get adequate arch support by putting high-quality, properly fitted inserts in all the shoes you wear.
- Avoid wearing shoes that are worn out, too flexible, or too stiff.
- Don't wear high heels.
- Avoid wearing flip-flops or any type of footwear that causes you to curl your toes while you walk.
- Properly and regularly stretch your calf and hamstring muscles (but only when plantar foot pain is not present).
- Massage and stretch your calves, bottom of your feet, and toes before you get out of bed.
- Minimize running on hard surfaces.
- Don't go barefoot (especially on hard surfaces).
Ice applications are often recommended for plantar fasciitis. However, there is some controversy as to whether plantar fasciitis is truly an inflammatory condition (in which case, ice applications would be appropriate) or if this condition is due to the degeneration of the materials that makeup fibrous connective tissue of the plantar fascia.
Of course, massage therapy can help treat plantar fasciitis. Your massage therapist can loosen and lengthen all the calf and hamstring muscles that may be putting extra stress on your plantar fascia. Your massage therapist can also locate and reduce any myofascial trigger points that may be increasing the tension on your plantar fascia and/or referring pain to the sole of your foot.
Even if you've never experienced the symptoms of plantar fasciitis, you would be wise to incorporate most of the measures above to prevent this painful (often difficult to eradicate) condition -- especially if you are in the high-risk category.
Don't Go From Bad to Worse
Plantar fasciitis pain usually generates enough motivation to start self-treatment measures and massage therapy. If plantar fasciitis is left untreated it can develop into an ongoing, painful condition. But even worse, constant or reoccurring irritation of the periosteum (the fibrous membrane that covers your bones) of the heel bone, caused by the pulling of an overly-tight plantar fascia, can stimulate the growth of a bone spur on your heel. This new condition, known as "calcaneal spur syndrome," can be extremely painful.
A Return to a Good Morning
Protect and nurture your soles so that in the mornings to come, that little extra hop in your step emanates from excitement for a new day and not from plantar fasciitis pain.
Bibliography
Biel, Andrew. Trail Guide to the Body. Boulder, CO: Books of Discovery, 2001.
Chaitow, Leon, and Judith DeLany. Clinical Application of Neuromuscular Techniques, Volume 2. Edinburgh: Churchill Livingstone, 2008.
Premkumar, Kalyani. Pathology A to Z -- a Handbook for Massage Therapists. Calgary, Canada: VanPub Books, 2000.
Rattray, Fiona, and Linda Ludwig. Clinical Massage Therapy. Elora, Canada: Talus Inc., 2000.
Simons, David G., Janet G. Travell and Lois S. Simons. Myofascial Pain and Disfunction, Volume 1. Baltimore: Lippincott Williams & Wilkins, 1999.
Tortora, Gerald J., and Sandra Grabowski. Introduction to the Human Body. Hoboken, NJ: John Wiley & Sons, Inc., 2004.
Werner, Ruth. A Massage Therapist's Guide to Pathology. Baltimore: Lippincott Williams & Wilkins, 2005.
