Foot Pain Part 1 – Rear foot and Mid foot pain
Conditions discussed in this article are: plantar fasciopathy (fasciitis), heal pain, and stress fractures. Part 2 will feature conditions relating to the ball of the foot (forefoot).
Are you suffering from foot pain? Pain while load bearing, walking, running, dancing or otherwise using your feet to get you around can seriously hinder your ability to do these things, as well as limit your enjoyment of the sport and leisure activities you love doing. While there are many causes of foot pain, most will experience a gradual onset of pain rather than experience an acute injury such as a sprain. Overuse will be the most likely culprit in this case. Overuse can occur by preforming the same movements or tasks over an extended period of time without adequate recovery time, or from a sudden increase in the demand we place on our feet, such as starting a new training program or drastically increasing the output of an existing one. Poor footwear can play a part in foot pain, however it is my firm belief that strong feet and a strong healthy muscular system trump orthosis and supportive shoes any day!*
Plantar Fasciopathy (formally Plantar Fasciitis)
This is most commonly experienced on the front edge of the heel where the planter fascia connects to the bone. The condition is characterised by pain with walking first thing in the morning, that eases as the foot warms up. Often the pain will return as the day progresses, or after the foot is allowed to relax and stiffen up again. Pain may also radiate along the arch of the foot towards the toes. This condition typically hinders people such as runners, dancers, and people involved in activities involving jumping such as footballers and basketballers.
Traditionally this condition was thought to be caused by inflammation and as such was treated as an inflammatory condition. However recent evidence sights a lack of inflammatory cells present in sufferers and are instead focusing on the degeneration of the fascial tissue as the cause of the condition (making it an overuse injury). Regardless, musculoskeletal interventions are required to resolve and manage the pain. These interventions can involve:
Monitoring and modifying training or workloads: activity plays a big role in the development of this condition; hence runners and dancers make up a good proportion of people who suffer from Plantar Fasciopathy (fasciitis). Studies have found that a greater training load is a predisposing factor to developing Plantar Fasciopathy (fasciitis) and is especially true when the training program has not be progressed gradually allowing the fascia time to adapt.
Assessing and correcting poor feet and ankle biomechanics, as well as poor global biomechanics: Flat feet (pes planus), high arches (pes cavus) and a bowed leg position (varus knees) are also risk factors in the development of Plantar Fasciopathy (fasciitis). Often these issues are subtle and through posture and biomechanical analysis can be identified and then treated through targeted strengthening and tissue release/lengthening procedures.
Soft tissue therapy to addresses muscle tightness: Tight muscles and fascial networks of the posterior chain (glutes, hamstrings, calves) also predispose someone to plantar fasciopathy (fasciitis). Stretching alone cannot deal with these issues due to the complex nature of the fascial collagen matrix and the role the nervous system plays in chronically tight muscles. Therefore, skilled musculoskeletal therapy must be applied to negate these risks.
Addressing lifestyle issues: Simple things such as selecting appropriate foot wear and managing body weight can also be used in the management of this condition.
If you are suffering from this condition, or have spoken to anyone who has, you would know that it is a debilitating and unpleasant condition that seriously limits your ability to participate in the activities you love doing, to stand or walk for long periods, or to function at work in some cases. All of which are key elements in maintaining good emotional, social and physical well being. Our feet are so important for getting us around, yet they are one of the most neglected parts of the body! No one wants to walk on sore feet! So why do so when there are ways to treat and manage and strengthen your feet and ankle to avoid this pain entirely! This is where Myotherapy can help! Not only are Myotherapists trained in treating soft tissue injuries but are also specialists in assessing biomechanics and prescribing exercises and at home treatment plans. This makes Myotherapy uniquely placed to not only treat the painful symptoms and offer relief, but also work with the client to address the underlying causes. A Myotherapy session can involve any number of specialised myofascial release techniques and nervous system desensitisation techniques. It should also include a thorough client history and biomechanical exam to determine the factors that are most likely contributing to the issue. From here, a personalised treatment plan can be developed. See here to discover more about an initial myotherapy appointment.
Bruised heel (Fat pad contusion)
With repeated heel strikes the shock absorbing soft tissue, known as a fat pad, can bruise. This causes a particularly uncomfortable or downright painful feeling when the heel is placed in a load bearing position such as standing or walking. People participating in sports on hard surfaces where running, jumping and change of direction is involved are particularly susceptible to this type of foot pain. Workers who are on their feet for long hours, particularly those who are required to wear dress shoes that offer little cushioning, can also be susceptible to bouts of bruised heel.
The location of the pain is what differentiates it from plantar fasciopathy (fasciitis). Pain is usually felt on the outside rear part of the heel where it makes contact with the ground during the gait cycle, whereas plantar fasciopathy (fasciitis) is more towards the middle of the foot on the front of the heelbone (calcaneus).
While rest and pain medication can alleviate the symptoms of this issue, it is more important to identify the cause and develop strategies to modify the activities that are injuring the fat pad itself. Assessing factors such as training programs for adequate rest/recovery periods, surface suitability, and the adequacy of footwear cushioning, will all go a long way to resolving the issue.
Myotherapy offers drug free interventions to this type of heel pain, such as sports taping of the heel and ankle. As well as this, the condition will be investigated, aggravating factors identified, and a treatment/management plan developed in consultation with the individual. This process not only ensures the best possible outcome in terms of pain reduction for the client, but by identifying the contributing factors and modifying elements within our control, we attempt to manage the situation and reduce the likelihood of re-occurrence.
Stress Fractures of the midfoot:
Overuse is again at play here, however poor technique can also be the cause of a stress fracture if the joints/bones are loaded repeatedly in a way that increases the ‘normal’ stress placed on the bone. There are multiple bones in the foot that are subject to stress fractures, and can occur from intense high impact training schedules or activities such as ballet dancing. Marked tenderness at the site of the stress fracture, usually under the arch of the foot, below, or just in front of the ankle. Difficulty load bearing are key signs that this has occurred. If a stress fracture is suspected, then the patient will be sent off for imaging to confirm or rule out the diagnosis.
In the case of all stress fractures, rest, and in some cases surgery, are required for the bones to heal and the patient to return to their normal activities pain free. Myotherapy can help to prevent and rehabilitate stress fractures by assessing biomechanical issues, releasing short muscles that may be stressing tendons and therefore boney attachment sites, prescribing exercise programs to strengthen the foot and ankle, as well as applying supportive taping or recommending braces if necessary.
As you can see, biomechanical issues play a big part in the development of foot pain. Knowing how to spot and address these issues was once the realm of the physiotherapist, however, when the biomechanical issue is caused or contributed to soft tissue weakness, tightness or imbalances, then Myotherapy is far more suited to treat all these elements due to the superior level of soft tissue knowledge. More so, at Reawaken Myotherapy we have years of rehabilitation experience, soft tissue treatment experience, and a desire to help your body perform without the need for constant treatment or the need for othotics! So if you are tired of dealing with foot pain, its time to book an appointment at Reawaken Myotherapy!
Written by Dan Hammond, Myotherapist (Bachelor Health Science – Myotherapy) and Master Functional Trainer (CertIV Fitness). 2018
Reference: Landorf w, Simons S, Jordan C, Rathleff M. Foot pain. In: Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K. eds. Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e New York, NY: McGraw-Hill. http://csm.mhmedical.com.ezproxy.endeavour.edu.au/content.aspx?bookid=1970§ionid=168696533. Accessed November 01, 2018.
*General statement only and does not take into consideration specific individual circumstances. See our disclaimer here.