Heel for heel and toe for toe…

(lyrics from ‘Mhari’s Wedding’, Highland folk song)

 Dancing at Highland weddings apart, there are many causes for chronic foot pain, which makes it a common long-term occurrence, affecting about 7% of the population, and lasting for up to 2 years on average.

A commonly diagnosed cause is plantar fasciitis, a name that confuses many people, not least about how to pronounce it.

Exactly what is plantar fasciitis?

Breaking it down, plantar is the anatomical term for the underside of your foot, fascia is the main connective tissue in the body and an ‘itis’ is an inflammation of the body part it is linked to. Hence plantar fasciitis means an inflammation of the fascia on the sole of your foot.

plantar fasciitis anatomy

Pain is usually the main symptom and is worse in the morning, with people describing their first few steps as hobbling on tight claws and getting better as they walk more. But typically the symptoms also worsen with too much walking or standing.

Although the pain is usually felt in the sole of the foot and the underside of the heel, many people also experience other symptoms such as pain in other parts of their foot, foot and ankle stiffness, and pain and swelling on the back of their heel. Medically these symptoms may be diagnosed as something else, such as tendonitis.

Sometimes pain can be due to a bone spur, which is an additional growth of bone tissue along a line of tension, ie if the tissues in your foot are too tight, they will exert an additional pull on the bony attachments and encourages additional bone growth.

Another culprit can be foot arches that are too flat or too high. Either way, an incorrectly functioning foot arch means a loss of the natural shock absorbing ‘springiness’ of the foot, and this exerts extra pressure on the plantar fascia which can lead to pain.

Medical approaches to foot and heel pain include medication (painkillers and anti-inflammatories), stopping any sport that aggravates, icing the painful areas, stretching, wearing orthotics or shoe inserts to support incorrect foot arches, and exercises to strengthen the calf muscles to support the heel and foot.

Whereas these approaches can help many people, there are many others whose feet have been through the medical mill and come out the other side still painful, which leads these people to wonder if the problem is actually in their foot, or maybe elsewhere in their body.

A fascial understanding

Looking at foot pain from a fascial perspective can help to explain some of the mystery around the causes. Fascia is the main connective tissue in the body and it creates a three dimensional web that wraps round and through all other structures, supporting the body and giving it form. Fascia can take many forms, from very fluid to more dense, and in the case of the plantar fascia it is at its naturally most dense, as it literally provides a solid base for the rest of the body. The fascia in this area is naturally thick and not very mobile, for who would want to try on walk on loose slidy fascia.

This natural tension, combined with the fact that the foot is literally at the end of the line of body tissues, means that additional tightness can easily build up for a variety of reasons. Any imbalance further up the line, whether in the legs, hips or even in the upper body, can have a knock-on effect as it changes the way we walk and stand.

Look elsewhere for the cause

To treat foot pain effectively, it is therefore essential to take a wholistic approach and look at what is going on everywhere in the body, not just the feet. Tightness in the sides of the hips, for example, can reduce or stop the natural rotation of the legs in the hips sockets as we walk or run. The force of the rotation is still there, ie your legs still want to rotate, but they just can’t do so freely any more. Instead this force gets transmitted down your legs, maybe causing knee pain for some people, but also foot pain for others.

Tightness in the calf muscles, and all the deeper muscles in your lower leg that are responsible for the natural flexibility of your feet and toes, can create a tension that is transmitted all the way down through your Achilles tendon, ankle and round the heel into the sole of your foot.

This tightness in the soft tissues is caused by fascial restrictions which develop in response to any body imbalance. These happen very gradually and incrementally, often over many years, to the point that you just don’t notice they are happening until one day you ‘suddenly’ develop pain. Only it’s not all that sudden after all, it has been on its way for a long time.

Myofascial treatment

Using myofascial release therapy to treat chronic foot pain can be extremely effective as it addresses the cause not just the symptoms. Certainly working on the plantar fascia itself can help to release tension, but it is also important to release restrictions in the hips, thighs and calves that will also be contributing to the problem. Often people are surprised by just how tight the tissues in these areas are, and what a profound difference it can make by releasing them.

Once tissues are released, using simple myofascial self-help exercises and stretches can help to prevent the problem from recurring, and allow you to get back to that Highland dancing. 

To help you on your way, here’s a short video with some myofascial help for Plantar Fasciitis.