Plantar fasciitis is a stubborn condition. It’s a pain under the foot that, at its worst, can persist for over a year. Treatment sometimes fails because the diagnosis wasn’t right in the first place. There are other structures in the foot and leg which can refer pain into the bottom of the foot, making you think you have plantar fasciitis…
Tightness in the muscles of the lower leg, namely the gastrocnemius and soleus muscles can refer pain distally down into the Achilles and heel area of the foot, and in extreme cases, referring pain onto the underside of the foot. If you stretch your calves and feel a pulling under your heel this may be the culprit.
Many patients with pain under the heel may go for a scan to find out they have heel spurs. Be careful before you go under the knife to get rid of these. The heel spur is the body’s attempt to heal the area under stress. So it’s sometimes a response to plantar fasciitis rather than the cause of the pain. According to some studies over 50% of patients who have heel spurs removed still suffer pain (Surgical Treatment of Calcaneal Spurs – A Three Year Study, J AM Pod Med Assc, 1991:81:68-72), because the pain originated in the damaged plantar fascia not the heel spur.
Nerve Compression or Damage
The tibial nerve runs down the inside of the lower leg, with branches ending up on the underside of the foot. As the nerve passes down the inside of the ankle it passes under a ligament known as the tarsal tunnel. This area can become congested with growths or scar tissue from a previous injury. Pressure on the nerve can then cause pain and numbness. This can be compounded by over pronation – the act of rolling from the outside to the inside of the foot on foot strike – which further stresses the tarsal tunnel.
Tight Extrinsic Foot Muscles
Two foot muscles – the tibialis posterior and the flexor hallucis longus – are stressed by over-pronation of the foot. Both muscles, when in dysfunction, can refer pain into the bottom of the foot.
As the foot leaves the ground at the end of an over-pronated foot strike, pressure is translated to the big toe which can over-stress the flexor hallucis longus (responsible for flexing the big toe). Rolling over excessively onto the inside of the foot on an overly pronated foot strike stresses the tibialis posterior (responsible for inverting the foot).
A Common Thread….
Poor foot mechanics, often over-pronation, are frequently the cause or a contributing factor to foot pain. So whilst getting your foot fixed don’t forget about addressing your gait (the bottom of an old pair of shoes usually tells an accurate story of how you walk) and getting orthotics/ new shoes to help the problem.
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