Almost any time there is pain, buzzwords like inflammation, inflamed, and the prefix -itis (which just means inflammation) can be thrown out haphazardly because inflammation is a component of most common pain symptoms.

More often than not this definition is a comp-out however, as its easy to blame inflammation for pain, but it fails to pinpoint why the inflammation happened in the first place.

Any time there is musculoskeletal pain, proponents of the “all pain is inflammation” theory will recommend ice and/or anti-inflammatory medications.

Ice is good for acute injuries (meaning within 3 days of the original injury) or when there is redness and swelling. For chronic pain presenting with no redness or swelling ice will decrease blood flow, cause muscle contraction and actually prohibit proper healing mechanisms. Anti-inflammatory medications do indeed reduce inflammation, but they don’t treat the root cause of the inflammation.

Anatomy

The plantar fascia is the tough fibrous band that connects the heel bone and the base of the toes

A common explanation of plantar fasciitis

Often times the structure of the foot itself is blamed, which is also a bit of a comp-out because you can’t change the structure of your foot, you just have to live with the structural abnormality there and perhaps buy expensive inserts or arch supports for the rest of your life.

The explanation goes like this: If your arches are too high, the plantar fascia will be excessively stretched every time you put your weight on your feet. Because of this frequent excess stretching the tissue gets inflamed and pain ensues.

Then what is the treatment? Stretching. So to summarize, excessive stretching caused your foot pain, and the solution is more stretching (if it’s hard to see the logic here you’re not alone).

Flat feet will also be blamed for plantar fasciits. I have not seen a good explanation for why this is the case but two possibilities are as follows:

1) The arch support of the feet has been broken down overtime due to overuse. So the length between the base of the toes and the heel is greater and thus the plantar fascia is stretched further than it would otherwise be.

2) Flat feet mean that more of the plantar fascia strikes the ground and this repeated trauma can lead to inflammation.

Symptoms

Doctors usually say that plantar fasciitis presents as pain in the heel. But as the plantar fascia extends all the way from the heel to the base of the toes, plantar fascia injury can present as pain almost anywhere on the bottom of the foot.

So why does it happen?

Pain at the bottom of the foot can be caused by excessive impact, uneven impact, poor posture, and periods of lack of use followed by excessive use.

Excessive impact

This is often the case for athletes, especially long distance runners. The bottom of the foot is covered in tendons and ligaments. Depending on the gait of the runner in question, one part of the foot strikes the ground first (or the inside of their shoe if you insist on being technical) with each step. This means the tendons are being smashed between the bones of the foot on top and the ground on the bottom over and over with each step.

This can cause a build up of scar tissue in the tendons and ligaments which can press on nerves, block circulation, and result in inflammation, all of which can lead to pain. Pain may happen in the arch, the heel, or closer to the toes depending on the gait of the runner in question.

Connective tissue acceleration can get the inflammation response where it needs to be to remodel the scar tissue, remove pressure from the nerves and open circulation, ultimately relieving the pain.

Uneven impact

Repeated uneven impact on your feet is like twisting your ankle slightly over and over again. This can compress the ligament between the tibia or fibula (the bones that connect the knee to the ankle) and the metatarsal bones (small bones of the ankle). It can also result in subluxations (minor dislocations) of the ankle.

In both cases, bone displacement or ligament injury; nerves may be compressed resulting in referred pain. This can result in pain on the bottom of the foot even when there is no pain in the ankle. (When nerves are compressed they malfunction and pain isn’t always felt at the sight of compression, sometimes it radiates along the pathway of the nerve). This is known as tarsal tunnel syndrome.

In this case the ankle must be treated. Calling this plantar fasciitis is incorrect and treating the bottom of the foot will be ineffective.

Connective tissue acceleration and tui na medical massage can resolve ankle compression/displacement to stop referred pain to the bottom of the foot.

Poor posture

This category often overlaps with lack of use. People who do not run, walk, or stand excessively can also develop plantar fasciitis simply from sitting too long.

The bottom of the foot is the farthest the blood has to travel from the heart (besides the toes, but you get the idea). Any postural insufficiencies while sitting can mild, moderate, or severe interruptions in blood flow to the feet.

The ligaments and tendons already anatomically receive less blood than the muscles due to their structure. When this is further interrupted by poor posture, malnourishment to these tissues can result in minor necropathy or tissue death. This will then be followed by a build up of scar tissue when the body tries to repair the dead or dying tissues, which ultimately results in foot pain.

Impingement of the nerves in the lower back can also result in foot pain. This is less common than foot pain being related to foot pathology but it still happens nonetheless.

Periods of lack of use followed by excessive use

This one principle results in a great deal of injuries and disease in addition to plantar fasciitis.

The human body is a very adaptable organism and will gradually adjust to stressors put upon it. So if an activity is performed every day the body will gradually get used to it and it will be less likely to result in injury.

But for people that alternate between long periods of inactivity followed by sudden excessive usage of the body, there is no time to adapt and injury can ensue.

This is often the case for weekend warriors. Five days of inactivity followed by a weekend of running or hiking does not give the body time to adapt. The tendons of the foot have become week while resting and the sudden use of them can result in micro tears and build up of scar tissue. Not to mention inactivity can reduce muscle strength and joint stability leading to a greater likelihood of ankle twisting. All of these things can result in foot pain.

Car Analogy: Cars need to be driven. Too long a period of sitting still leads to the build up of rust and moving parts adhere together. That makes for friction when you finally do use the car which can lead to overheating and engine failure.

So what do I do?

Make an appointment at Roots of Eastern Medicine Acupuncture Clinic, where Acupuncture, Tui Na Medical Massage, and Connective Tissue Acceleration will be integrated to relieve the pain in your foot.

Obesity

Almost every pain from the lower back down to the feet can be blamed on obesity. Sometimes a doctor who has given up on a patient will blame the patient for their problems instead of taking responsibility. But indeed obesity is a problem for lower body pain much the same way heavy lifting is a problem. It’s just physics, and there is only just so much weight the joints can handle before stability becomes a problem.

The solution is to treat your foot simultaneously while you make lifestyle adjustments to decrease your weight and thus decrease the impact on your feet. Treatments at Roots of Eastern Medicine Acupuncture will eliminate your foot pain to allow you to exercise.

Such treatments will be on one part palliative, on one part curative. They are palliative in the sense that as long as you are overweight your foot pain will eventually return. But they a curative in the sense that excessive impact does indeed lead to micro-trauma to the feet and connective tissue acceleration can remodel the scar tissue that results from the micro-trauma. So when the pain comes back due to exercise, I can help eliminate it so you can keep on exercising.