Plantar Foot Pain

The feet are responsible for carrying us through and are prone to several incidences of being hurt thereby causing pain. Pain at the heel may be an indication of plantar fasciitis which is an inflammation of the ring of tissue that connects the heel bone to the toes (Mayo Clinic, 2017). Heel spurs are a different type of foot pain in the form of abnormal growths of bone at the bottom of the heel. The cause of such pain is wearing the wrong shoes and having an abnormal walking style or posture. Another type of pain is stone bruise which is deep within the fat pad of the heel. Its cause is an impact injury but also happens after stepping on a hard object. The focus of the discussion in this research is plantar foot pain (plantar fasciitis) based on various issues.

Relationship of myofascial pain to the plantar foot region

Myofascial pain is a persistent muscle pain that gets worse with time and its chronic, non-fatal, and non-inflammatory condition affecting fascia and connective tissues covering the muscles. The pain experienced usually centers around the trigger points which are felt as nodules or rope-like bands beneath the skin (Gerwin, 1999). Discomfort in the heel of the foot is a common form of injury referred to as plantar fasciitis. Since the heel of the foot is highly sensitive to the developing sensitive and painful, inflamed areas, it leads to myofascial pain. Among the major causes of myofascial pain is the damage to the posterior tibialis tendon. The injuries are repaired surgically, but little attention has been accorded to studying plantar fasciitis in the early stages. Scientists have developed a special test for identifying the foot pain which involves measurement of the tightness of the posterior myofascial tibialis (Renan-Ordine et al., 2011). Tibialis posterior tendon follows three stages. First, the foot pain is mild, and a person does not feel it, but upon examination, there is a likelihood of swelling and tenderness in the heel. Secondly, the injury may be severe due to long-term damage, and the person may experience pain even when not standing, and the swelling and tenderness can be seen. The patient complains of myofascial pain in the morning, and the pain reduces during the day. Many patients cannot exactly tell what led to the plantar fasciitis. Stage three involves the tendon being fully ruptured and the patient complains of persistent plantar fasciitis pain.

Referral patterns and common trigger point symptoms

The muscles of the lower leg are foot muscles referred to as extrinsic foot muscles which imply that they operate outside the foot. The muscles within the foot are intrinsic meaning that they operate inside the foot. The idea implies that foot pain may not be arising from the feet themselves, but may be referred pain from the trigger points in muscles of the lower leg. A common misconception about trigger point therapy is that it is effective for short-term pain relief. However, it is not the case for plantar fasciitis which develops in one or both feet and causes acute heel pain. Plantar fasciitis is associated with trigger points in the gastrocnemius, soleus, plantaris, and quadratus plantae muscles. The trigger points are well accessible, and patients are encouraged to work on them between treatments through stretching, strengthening, and simple lifestyle changes (Davies & Davies, 2013).

The diagnosis of plantar fasciitis is mistakenly applied when physicians are not fully aware of myofascial pain. Trigger points refer pain and physicians may not be fully aware of it. The pressure applied to the arch of the foot is the test for determining whether one has plantar fasciitis. The tendons and fascia in the bottom part of the foot are inflamed upon applying pressure and practitioners are aware that it is the spot where there are trigger points in the flexor digitorum brevis and quadratus planta muscles of the foot. Their pain referral is towards the bottom of the foot, especially on the heel. When wrongly labeled plantar fasciitis, heel pain is falsely blamed on heel spurs. Trigger points in the soleus muscles are the main cause of heel pain (Martin et al., 2014).

Symptoms associated with trigger points and symptoms related to alternate conditions

In the discussion of the symptoms associated with the trigger points and the alternate conditions, it is also important to understand the causes of plantar foot pain. Plantar fasciitis is an injury that results from over-stretching the planar fascia thereby causing inflammation and thickening of the tendon. Overuse makes the fascia inflamed and painful at the point of attachment to the heel bone. The condition is considered as inflammation, but it has been ruled out due to lack of actual inflammatory cells within the fascia. Hence, degeneration is considered to be the more probable cause of the pain (Bartold, 2004). Despite overuse being the main cause of injury, other factors that contribute to its development include overpronation, high curved foot, tight calf muscles, poor choice of footwear, and being overweight.

The concept of trigger points helps to demonstrate the procedures used in finding and eliminating the appropriate trigger points. A collection of trigger points build up in a small section of the body and result in myofascial pain syndrome. Trigger points are the major reason for pain in the feet, toes, and ankles and a large percentage of all the cases of pain are due to trigger points (Riddle, Pulisic, Pidcoe & Johnson, 2003). The deactivation of the trigger points in the muscles has a potential of resulting in significant pain relief. Thus, one needs to identify an area of the soleus muscle that requires attention. The symptoms associated with the trigger points include intense pain in the heel and the food, especially when getting out of the bed. The prolonged periods of immobility leads to muscle stiffness caused by the trigger points. The pain may reduce as one walks and stretch the muscles out. However, any additional stress during the day is likely to increase the severity of the pain.

The symptoms of plantar fasciitis related to alternate conditions are diverse and help to describe the specific experiences that patients go through. Patients report of sharp pain that occurs as they make their first steps in the morning. After the foot relaxes, the pain in the plantar fasciitis decreases but has been observed to reappear after an extended period of standing or getting up from a sitting posture (Buchbinder, 2004). An incidence of sudden stretching of the sore of the foot tends to increase the pain, and in extreme cases, symptoms include numbness, tingling, and swelling.

One muscle that refers pain to the area

The common muscles and trigger points that cause pain to the region are gastrocnemius, the soleus, and the tibialis anterior. The focus of this section is in the gastrocnemius muscle which is a group of a large muscle that makes up the bulk of the calf. It forms an attachment to the large leg bone, slightly above the bend of the knee and running down to attach to the Achilles tendon. The muscle contracts to lift the body onto the toes as one walks runs and jumps (DiGiovanni & Langer, 2007). Four distinct trigger points can develop in the muscle and refer pain to foot arch, calf, and the back of the knee regions that may cause cramping at night.

The action of the gastrosnemius involves pulling the heel up and extending the foot downward thereby providing the propelling force to run and jump. The activities such as; heel raising and standing on the ball of the foot, make the muscle big and strong thereby giving the leg an attractive shape. The top of the muscle is attached to the femur, and the bottom forms part of the Achilles tendon which attaches to the bone at the back of the foot. Achilles tendon has two muscles; the soleus and the gastrocnemius (Cheung, Zhang & An, 2006). The soleus is found deep and behind the calf muscle and does not usually has problems, unlike the big gastrocnemius muscle that causes pain and symptoms. Upon walking, the muscle contracts and lifts the heel from the ground thereby causing a propelling force. The gastrocnemius muscle can be short thereby contributing to problems such as flat feet, metatarsalgia, capsulitis, curled fifth toes, plantar fasciitis, and Achilles tendon inflammation. The tightness of the muscle is tested by the measurement of the amount of motion at the ankle joint by having the knee flexed and extended (Pinney, Hansen Jr & Sangeorzan Jr, 2002). Tight gastrocnemius muscle accounts for the majority of the foot problems and is ignored during examination and treatment. Tight gastrocnemius tendon generates much pain, and the relaxation of the tendon using an elevated heel produces significant pain relief. As such, tight Achilles tendon around the gastrocnemius portion is a major cause of pain in the foot, but it is frequently ignored. Almost every adult experiencing pain at collapsing flat foot may be due to tight gastrocnemius muscle (DiGiovanni & Langer, 2007).

Corrective actions and advice to patient to limit the activation and perpetuation of trigger points

There are various methods of addressing plantar foot pain but usually narrows down to taking rest, reducing pain and inflammation, and performing stretching exercises. The corrective actions for planar fasciitis consist of a reduction in the painful symptoms, stretching the tight fascia and lower leg muscles, correcting the causes, and eventual returning to fitness (Zapf, 2011). The use of combined approaches works effectively in treating the injury. The reduction of pain and inflammation is the main priority in the corrective actions and is addressed by applying the PRICE principles of protection, rest, ice, compression, and elevation. The use of ice or cold therapy helps to reduce pain and inflammation which takes about 10 minutes every hour. The ice is not applied in the form of direct contact with the skin to avoid skin burns. Foot tapping is also an effective way of relieving the symptoms and pain under the heel by use of methods such as applying tape for an injury. Some strain is applied on the plantar fascia thereby allowing the tissues to heal.

The foot should be protected by wearing comfortable shoes. Flat and hard soled shoes may worsen the symptoms, hence necessary to wear shoes that protect the painful area under the heel. Simple tapping of the plantar fasciitis can be effective for taking the pressure off the plantar fascia and also allowing the foot to rest and heal. Plantar fasciitis stretches can be effective if the patient can do them. In some instances, a night splint is an effective method of stretching the plantar fascia beneath the heel (Cole, Seto & Gazewood, 2005).

Professional therapists assist in making an accurate diagnosis by use of electrotherapy to relieve the symptoms and also manual techniques such as massaging (Cotchett, Munteanu & Landorf, 2014). Physicians may prescribe anti-inflammatory drugs such as ibuprofen, but for serious injuries, a corticosteroid injection may be effective, and surgery can also be used for the persistent symptoms.

There are specific exercises that help to address the problem of plantar fasciitis. The exercises for stretching the plantar fascia focus on strengthening. The calf muscle stretches when the leg is straight thereby targeting the larger gastrocnemius muscle, and having the knee bent to target the lower soleus muscles. The exercises can be done three to five times a day where the stretches are held for 30 seconds at a time. The stretch of the plantar fascia is accomplished by pulling the foot and toes in an upward manner with the aim of stretching the arch of the foot (Cole, Seto & Gazewood, 2005). An activity of rolling the foot over a ball helps to stretch the base of the foot.

If the corrective actions discussed above fail to improve the symptoms, surgery for the plantar fasciitis can be used. However, the success rate is low averaging to 70%. The common procedure in such cases is plantar fascia release that helps to reduce to pull and stress on the bone attachment and the fascia.

References

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Buchbinder, R. (2004). Plantar fasciitis: New England Journal of Medicine, 350(21), 2159-2166.

Cheung, J. T. M., Zhang, M., & An, K. N. (2006). Effect of Achilles tendon loading on plantar fascia tension in the standing foot: Clinical Biomechanics, 21(2), 194-203.

Cole, C., Seto, C., & Gazewood, J. (2005). Plantar fasciitis: an evidence-based review of diagnosis and therapy. Am Fam Physician, 72(11), 2237-42.

Cotchett, M. P., Munteanu, S. E., & Landorf, K. B. (2014). Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Physical therapy, 94(8), 1083-1094

Davies, C., & Davies, A. (2013). The trigger point therapy workbook: Your self-treatment guide for pain relief. New Harbinger Publications

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Mayo Clinic (2017) planar fasciitis: Overview, symptoms, causes, diagnosis, and treatment.

Pinney, S. J., Hansen Jr, S. T., & Sangeorzan Jr, B. J. (2002). The effect on ankle dorsiflexion of gastrocnemius recession: Foot & Ankle International, 23(1), 26-29.

Renan-Ordine, R., Alburquerque-SendÍn, F., Rodrigues De Souza, D. P., Cleland, J. A., & Fernández-de-las-Peñas, C. (2011). The effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. Journal of orthopedic & sports physical therapy, 41(2), 43-50

Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). Risk factors for plantar fasciitis: a matched case-control study. JBJS, 85(5), 872-877.

Zapf M. (2011) The tight gastrocnemius: Is it the root of most food pain?

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