While heel pain can be caused by a problem in the heel, often the pain has nothing to do with the foot… if special shoes, heel cups and anti-inflammatory medications aren’t helping, read on!
In the diagram below, stripes show where pain is felt and the dot is where the problem originates.
How I learned about it…
Years ago, I was diagnosed with plantar fasciitis (inflammation of the fascia covering the bottom of the foot). I bought new expensive shoes, bought heel cushions, took Advil and rubbed anti-inflammatory cream on the bottom of my feet. It seemed to help but the problem never went away.
Then my brother-in-law, also a pharmacist, told me sometimes heel pain can be caused by a muscle spasm in the calf. Really? Hard to believe, but I was ready to try anything… walking was so painful. Instead of rubbing anti-inflammatory cream on the soles of my feet, I rubbed it on my calf muscles. I massaged my calves and stretched the back of my legs. And, wow, it worked! Whenever I felt any pain in my heels, I stretched my calf muscles and it disappeared right away.
Later I read how a muscle spasm or damage can “refer” pain to a different area of the body, making you think your problem is somewhere else. All your careful treatment of the painful area gives little relief because the source of the pain is elsewhere. A heart attack is a classic example of this – damage to the muscle of the heart (caused by lack of oxygen when a clot blocks its blood supply) is often felt in the jaw or left arm instead of in the chest where the problem really is.
The pain from a particular muscle tends to form a consistent pattern. Doctors Travell and Simons mapped out these pain patterns in the 1950’s and their work formed the basis of massage therapy. Unfortunately, most health professionals do not learn about muscle pain and its quirks. This means muscle pain is frequently misdiagnosed.
Fast forward to this year…
Now I have an odd pain near the toe joints of one foot. Some days it’s so bad I can hardly walk but it gets better once I walk (limp!) around a bit, and if I wear soft padded shoes. My doctor diagnosed it as arthritis, but that doesn’t seem to fit (or maybe I’m just too stubborn to accept a diagnosis that has no cure and no treatment other than pain medication). She suggested I consider custom orthotics and physiotherapy…
My physiotherapist figured out that my beautiful (and expensive) sandals were the problem – and I walked over 150km in them while in Spain. One sandal tilts slightly to one side causing me to do strange things with my foot (picture hanging on with your toes while your foot is slipping to one side…). I immediately threw them in the garbage and faithfully did the exercises she gave me. My foot was better but it didn’t clear up completely.
It took me a while, but eventually I realized there could be a similarity to the heel pain I had years ago. I dug out my trusty manual that is based on Travell and Simons and flipped to the section on feet… and there it was! A muscle spasm in the “flexor digitorum longus”, a muscle in the back of the calf. When I press on the area it is very tender, but I feel no pain in my calf at all when I walk. The pain all “referred” to my foot… The dot in the diagram is called a “trigger point” – an area where a muscle spasm is focused, and it’s the best place to treat a spasm. Often a muscle will relax if the trigger point is pressed and massaged.
This calf spasm was very likely a second way my body was trying to compensate for a tilted shoe. My physiotherapist once told me that there is rarely only one trigger point… the body eventually creates several spasms as it tries to adjust to a weak or injured area.
So, now I’m stretching my calf and rubbing my anti-inflammatory/muscle spasm cream on my “flexor digitorum longus” muscle that is causing so much pain. It will take a while to work out the “trigger point” knot deep in the muscle, but my foot is starting to feel much better already.
Custom orthotics?
As for custom orthotics (insoles), a new study published in the British Journal of Sports Medicine this week says expensive custom ones are no better than "off-the-shelf" insoles for plantar fasciitis foot pain. After my experience, I can’t help wondering if any insoles really help--especially when the problem originates in the calf muscles--but they feel nice when you have them in your shoes...
If you have stubborn foot pain that won’t go away, no matter what you try, see a physiotherapist or massage therapist that follows the work of Travell and Simons. Muscle pain is tricky and often disguises itself as “joint pain” or “arthritis”. Knowing where your pain originates and treating the source can make all the difference in finding a cure. Too often we treat the symptoms and not the cause in our medical system.
By the way, my favourite book on all this is The Trigger Point Therapy Workbook by Clair Davies. It explains trigger points, where their pain is referred, and how to treat them. It’s designed as a self-treatment guide you can use yourself. I added links to sources of the book in the references, if you're interested.
References:
The Trigger Point Therapy Workbook – Amazon Canada ; Amazon US ; or AbeBooks
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