Is My Foot Pain Really Plantar Fasciits, and Why Won’t It Respond to Treatment?
Oct 21, 2013
By Dr. Josh Bross
Every day at our Howard County chiropractic location, I see patients who have foot pain. I think it would be safe to say just about 100% of these people either have been diagnosed with Plantar Fasciits by a medical doctor, podiatrist, physical therapist, or chiropractor. Literally, 100%! Is it possible that every single person that has foot pain has this “itis” in the bottom of their foot?
The “itis” of any condition means there is an inflammatory component. Inflammation is the result from muscle or fascial tearing. Usually inflammation occurs with any injury immediately, and lasts for 48-72 hours. If everything works well, your body is able to contain the site, repair any damage, and rebuild the injured tissue. However, if there is continuous stress to any area that is injured, the process of healing can be compromised, leading to chronic changes in the tissue. The inflammation leads to scar tissue formation, which causes weak and tense tissues, leading to pressure and tension in the area. This tension then makes it easier to re-injure the area, leading to a viscous, self-perpetuating cycle.
I googled “plantar fasciitis”, and according to Wikipedia, Plantar fasciitis (PF) is a painful inflammatory process of the plantar fascia, the connective tissue or ligament on the sole (bottom surface) of the foot. However, this definition, or diagnosis, doesn’t seem to apply to anyone who has had this injury for more than a few days, let alone a few years. For most people that come to our office, they have been dealing with pain for a lot longer than what is considered acute, so why diagnose this as an “itis”?. The injured area now should be considered more of an “osis”, or chronic pathology.
Now that we have established the name itself it incorrect, let’s talk about the fact that a majority of this foot pain isn’t even at the plantar fascia!
Refer to the diagram above.
The green arrow is pointing to the plantar aponeurosis, which makes up most of the plantar fascia. The fascia also is located on both sides of the aponeurosis (not shown in diagram). You can see, with the yellow arrows, a couple of muscles of the foot.
In the second picture, we have removed the plantar aponeurosis/fascia, so you can see more muscles underneath. I have numbered 5 different muscles in the foot to give you an idea of the complexity of the foot, that’s it’s not just the “plantar fascia” that can cause pain. In fact, just beneath the fascia of the foot, lies (#1 in the diagram) the Flexor Digitorum Brevis. Beneath that, there is a muscle called the Quadratus Plantae. To each side of the foot, there are muscles controlling various aspect of foot mechanics and toe motion. One, or a combination of these muscles, not the fascia, is often the culprit when it comes to foot pain.
Now we move on to the treatment aspect of “plantar fasciitis”. The common or standard treatment usually consists of rest, ice, over the counter pain relievers, rehab, night splints, and cortisone injections. Rehab, which often consists of calf stretches, and night splits both aim to stretch the calf and foot. The problem is that, knowing this is more of a chronic injury that was stressed and stretched too much to begin with, why would we continue to do that? That seems a little counterintuitive, doesn’t it? Maybe an incorrect diagnosis, combined with an erroneous treatment plan, is the reason why so many people can’t get help with their foot pain. Countless hours of stretching, icing, exercise, medication, cortisone shots all can be completely ineffective.
These people begin to think they will always have to live with their foot pain, that there is nothing that can be done about it. If you understand the anatomy and mechanics of the foot and lower extremity, you can effectively hone in on the site or sites causing the problem, and fix it! Who’s ready to get rid of night splints, calf stretches, shots, and medication??!!
Schedule a visit at our Howard County Chiropractic office to forget what’s it’s like to be in pain.