Plantar Fasciitis: The Pain That Won’t Go Away?

By Bill Cioffredi, PT

Heel pain is a common complaint among approximately 2 million people per year, and nearly 10% of the population over a lifetime. 1 The diagnosis for pain in the heel or arch of the foot is called plantar fasciitis. I’m always impressed when folks have indicated that their problem took a year to heal. Muscle and connective tissue usually heals much more quickly than that. Are there other factors that are stimulating the pain?

In earlier years I asked myself, what is going on with this problem? I treated a lot of people who got better with some combination of basically flexibility exercises, proper shoes, and/or orthotics, using floor mats to cushion standing work areas, and correcting faulty biomechanics from the spine on down.Trigger Point in Gastrocnemius Muscle Diag

Interestingly, while some people were runners, most people had developed the problem gradually with no specific precipitating event and were not even doing a sport. How could the Plantar Fascia, the leathery-like tissue in the arch to the heel, get strained or bruised to result in so much inflammation?

What if the irritability was driven from another area? Janet Travell, MD, the doctor who cared for John F. Kennedy for his severe back muscle spasms was one of the pioneers who evaluated and mapped out painful conditions that are ‘Myofascial’ in nature, muscle and surrounding connective tissues, that were responsible for specific painful conditions. Two specific muscles in the lower leg, the gastrocnemius (see figure 1) and the soleus (see figure 2), have areas that can cause pain in the arch and the heel respectively. People who have ‘Trigger Points’ in these muscles, areas of hyper irritability, are people that can have this pain. Trigger points can be ‘latent’, that is, they are present, but not active.

It makes sense that stretching can help affect these areas of hyperirritability. The concept of latent Trigger Point in Soleus Muscle Diagramtrigger points is consistent with the history that many people have of the onset of their pain. It came on for no apparent reason. When stretching alone doesn’t eliminate the pain, effective soft tissue manipulation will resolve the effect of the trigger point pain.

There are people whose onset was associated cumulative loading of their lower leg such as a runner or dancer who were building up their training time or practice time to the point that they cross over their physiological limits. These people readily respond to relative rest, appropriate stretching, addressing any biomechanical restrictions/abnormalities from the spine down, temporary taping of the foot, and in some cases, custom orthotics.

Those who don’t, I would recommend be evaluated for trigger points.


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1. Risk factors for plantar fasciitis: a matched case-control study. Riddle DL, Pulisic M., PidcoeP, Johnson RE. J Bone Joint Surg Am. 2003;85-A:872-877

Figures 1 & 2: Janet G. Travell, MD and David G. Simons, MD, Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 2, (Baltimore: Williams & Wilkins, 1992)