Foot Pain and how massage Therapy can Help

Massage Therapy for Foot Pain
Working as a Toronto RMT, I have seen many injuries, aches and pains. Recently, I noticed an influx of clients suffering with foot pain. I have also noticed that many of these people were simply told to get expensive orthotics and everything should be ok. Unfortunately, in most cases, the orthotics were not the miracle cure they were promised and this is why they came to see if Massage Therapy could help. This  influx of foot pain clients inspired me to write this post because when dealing with foot pain or Plantar Fasciitis, education on how the injury occurred, what is currently causing the pain and how we can fix it, is just as important as the massage treatments themselves. Since the mechanisms of the foot are incredibly complicated, I will try and simplify things to make it more reader friendly.

In order to understand how most foot pain starts,  it is important to have a broad understanding of the foot anatomy and its bio-mechanics.

Foot Anatomy

Like I said earlier, the foot anatomy and bio-mechanics are incredibly complicated and in reality we would have to talk about the body as a whole in order to get the complete picture.  Since I’m sure you don’t want to be reading this for the rest of the week, I will keep it simple and focused.

Most foot pain is located either on the bottom of the foot, the heel or on the outside of the foot. Even if pain is felt in different locations, they usually have one common origin: Stress on the Plantar Fascia.

 

Plantar Fascia

The Plantar Fascia in a very dense ligament like tissue that is located on the bottom of the foot. It runs from it’s attachment on the bottom of the heel (where it connects with the achilles tendon) to the beginning of the toes. This Plantar Fascia has slight give to it and helps support the arches of the feet. The arches are very important because they are like small springs on the bottom of the feet that help absorb some of the stress and shock of weight bearing when you walk, stand, run etc….  This helps decrease the wear and tear on other joints like your knees, hip and back.

The arches of the foot are also supported by small muscles. They are located at the bottom of your foot and have two purposes:  They move the toes and support the arches. There are too many to name them all and they have really weird names so we will simply call them the intrinsic foot muscles.

 

Intrisic foot muscles

Now remember how I said the plantar fascia has a connection to the achilles tendon? Well, this is important because this connection can play a major role in foot pain. The achilles tendon connects to the calf muscles (yes, there are 2) the Gastrocnemeus and the Soleus. These 2 muscles make up your calf muscles, which run all the way to the back of your knee. Once at the back of the knee the calf muscles have a Fascial connection to the muscles located at the back of your thigh called the hamstrings. Since both of these muscles groups are very strong and active in almost everything we do, they tend to get quite tight and as you probably guessed by now, since everything is connected tightness in one area can quickly lead to problems elsewhere.

 

Connection between The plantar fascia and all the muscles of the posterior leg.

So to summarize the hamstrings run along the back of the tight, down to the knee.  There they connect to the calf muscles that turn into the achilles tendon which attaches to the heel. Here, it connects to the dense ligaments like structure called the Plantar Fascia, which supports the arch of the feet.  Also supporting the arch of the feet are the small instrinsic foot muscles. Now in a perfect world, if these muscles and Plantar Fascia are healthy and loose, this design works perfectly. Unfortunately this is often not the case.

What is Plantar Fasciitis and how does it begin?

Plantar Fasciitis is when the plantar fascia ( ligament like structure that support the bottom of the feet) becomes irritated and inflamed. The irritation can be caused by many factors:

Tight muscles

  • If the calf muscles and hamstrings are really tight, it will pull on the achilles tendon, which will pull on the plantar fascia, making it really tight. When the Plantar Fascia is tight, it loses it’s ability to slightly stretch when weight bearing. This causes the tissue to develop mini tears with every step. These mini tears will cause inflammation and pain in the Plantar Fascia. Once this initial flare up calms down, the mini tears will start healing with the development of scar tissue. Since scar tissue has no ability to stretch at all, this build up will cause the Plantar Fascia to become even tighter and more rigid. As the plantar fascia progressively loses it’s ability to give slightly during weight bearing, a microtearing-scar tissue development cycle will develop and the pain will progressively get worse.

Weakening of Intrinsic Foot Muscles

Another cause of Plantar Fasciitis is the weakening of the intrinsic foot muscles. This can be caused by both wearing over supportive shoes and wearing under supportive shoes. Weird, I know…but both are very common causes of weak intrinsic foot muscles.

Over supportive shoes will support the feet so much that the small intrinsic foot muscles barely have to work to support the arches and maintain balance. Since the muscles  don’t have to work as much, they eventually get lazy and become very weak. Remember, if you don’t use it, you lose it!  Since one of the 2 structures that support the arches are now very weak, all the weight of the body has to be supported by the other; the Plantar Fascia.  Although the Plantar Fascia is very strong, it was not designed to support ALL the body weight and therefore, it gradually stretches, tears, becomes inflammed and develops scar tissue.  This commonly happens when people switch from shoes and boots to sandals and flip flops in the summer.

Under supportive shoes usually becomes a problem for people who stand for prolonged periods of time. When standing, the small intrinsic foot muscles are constantly working and like all muscles if overworked, they become tired and eventually weak.  This fatigue and weakening of the foot muscles will cause a increase in strain on the plantar fascia, because once again, it has to take over the entire task of supporting the arches. Slowly the Plantar Fascia will stretch, tear, become inflamed and the arches will collapse over time. This is where Supportive orthotics are VERY useful. (I use them when I’m at work)

Foot Injury

A simple injury to the bottom of the foot can sometimes lead to plantar fascia issues. It can be a simple as stepping on something painful or walking for a really long time when your feet aren’t used to it or changing your shoes. All of these can lead to micro trauma to the Plantar Fascia. This small amount of trauma can lead to inflammation and scar tissue development.

Nerve Irritation

Tightening of the bottom of the foot can also be caused by sciatic nerve irritation. The sciatic nerve comes out of your spine at the low back. It then travels down the back side of your leg, all the way to the bottom of the foot. On its way down it innervates all the muscles of the back of the leg and yes, the intrinsic foot muscles and surrounding tissues. If this large nerve gets irritated( usually in the low back where it exits the spine) it will cause all the problems.

So, as you can see there are many things that can lead to Plantar Fasciitis. The reason it is so important to understand the causes is because in order to eliminate the pain more permanently the cause MUST be addressed. It is also very important to begin treatment as soon as possible, because the quicker the cause is addressed, the easier it will be to get rid of the pain. Not sure if you might be suffering from Plantar Fasciitis?  Check out the signs and symptoms to see if any of them sound familiar.

Signs and Symptoms

  • Problems with the plantar fascia and intrinsic foot muscles can start gradually (most common) or suddenly.  Gradual irritation occurs when the plantar fascia is taught and microtearing occurs. Over time, there is more and more tears; meaning more and more scar tissue develops.
  • Sudden irritation can be caused by direct trauma, like stepping on something really hard or by walking for a really long time is new or uncomfortable shoe.
  • Pain is usually worst in the morning, when you first step out of bed, but then calms down at bit as you walk around and the tissues warm up.
  • Pain is usually located in the arch of the foot or on the heel. (where the plantar fascia attaches)
  • Feet can feel really stiff and hard when walking
  • Sometimes symptoms come and go, depending on how active you are, and what footwear you are using.

If any of the previous sign and symptoms seem familiar you may be dealing with Plantar Fasciits. Don’t worry though, because something can be done!

Massage Therapy and Plantar Fasciits

Although there are other methods of treatment for Plantar Fasciitis, this article is going to concentrate on how Massage Therapy can help.

During your first visit with your RMT, he or she will most likely perform a quick assessment to determine what might be causing your Plantar Fasciitis (at least I would). Specific orthopedic tests can help us determine whether your muscles are too tight or if your arches are falling and can even tell us if you have sciatic nerve irritation. After your RMT determines the underlying cause of your foot pain, he or she will develop a treatment plan that will address the foot as well as the initial cause of the foot pain.

Foot Treatment

As explained earlier, scar tissue commonly develops in the Plantar Fascia. This scar tissue develops in a big unorganized mess that feel like nodules and crunchy stuff under the foot. Unfortunately this scar tissue needs to be broken up and loosened in order to prevent the tissues from re-injuring themselves (you can not completely get rid of scar tissue, if someone says they can, they are lying.). Once the scar tissue is no longer stuck together in a big ball, it is a bit more pliable and wont tear as easily.

Breaking up scar tissue can be tough and the treatment is usually quite aggressive. To help decrease the discomfort, the therapist usually uses moist heat to warm up the tissues. This makes the scar tissue a little softer. Your therapist will either use her or his fingers or a small tool to friction the scar tissue in the plantar fascia. Like I said before, this can be a bit painful, so make sure you let your therapist know if it is getting to be to much.

Once the Plantar Fascia is released the intrinsic foot muscles are worked to decrease the tension and strain in them. Then, all the joints of the foot are mobilized to return normal movement in between all the little foot bones. After every thing is released and moving like it should, the bottom of the foot is stretched out and then iced to get rid of any inflammation left in the tissues.

Global treatment

While the foot is being iced, the therapist then addresses all the other tissues that might be involved in the development of the Plantar Fasciitis. These areas usually include:

  • The calf muscles
  • Hamstrings
  • Gluteals
  • Low back
  • Other leg

By performing a specific foot treatment as well as working globally, Massage Therapy is a very effective way of getting rid of your foot pain quickly and in most cases permanently. But, in order to have more permanent results, there are a few simple exercises that are really important to perform daily.

Home Exercises

These simple home exercises are really important  because they will help re-lengthen and re-strengthen some of the muscles that are contributing to your foot pain.

1.  Calf Stretch

Sit on your bed or couch with the affected leg stretched out. Grab a towel and wrap it around your toes, holding on the the two ends of the towel.  Pull the two ends of the towel towards your body, which will pull your toes up towards your knee.  Hold for 30 seconds, then bend your knee and hold for another 30 seconds.

Watch video for Calf Stretch here

2.  Towel Toe Crunches ( strengthens the intrinsic foot muscles)

Place a towel on the floor, then put your foot on the edge of the towel. Crunch the towel up with your toes until it’s all bunched up. Spread it out again and repeat this process 3 times

Watch video of exercise here

3.  Self Ice Massage

Fill a plastic water bottle with water and put it in the freezer. Once it’s frozen, place the bottle on the floor with  the arch of your foot on the bottle. Press down slightly and roll the bottle back and forth in the arch of your foot. The hardness of the bottle will massage the foot, and the ice will get rid of any inflammation in the Plantar Fascia.

Watch video of Self Massage for foot pain here

4.  Foot Alphabet

Before getting out of bed in the morning, use your foot to trace out the alphabet. This will warm up the ankle and foot muscles so they wont be as stiff in the morning when you get out of bed.

Watch video of Foot Alphabet exercise here

Even if you haven’t started treatment for your foot pain, I strongly suggest starting this daily exercise routine to help reduce your discomfort and speed up your recovery time.

If you have any questions about your foot pain, Massage Therapy and if it can help you, do not hesitate to call us at 416 995 6601 or email at myocarermt@gmail.com.  Our Massage Clinic is located in Toronto, in the Annex district.