According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, myofascial trigger points (tiny contraction knots) in overworked or poorly conditioned muscles are the most frequent cause of pain in the ankles, feet, and toes.
Travell and Simons believe that a diagnosis of plantar fasciitis or heel spurs is often mistakenly applied when physicians are uninformed about myofascial pain. Trigger points typically refer pain; that is, they send pain to some other site. Physicians and other healthcare workers are commonly led astray by this phenomenon.
Pressure applied to the arch of the foot is often the test used for determining whether you have plantar fasciitis. If it hurts to press there, the tendons and fascia in the bottom of your foot are presumably inflamed.
Few practitioners are aware that this spot is where you will find trigger points in the flexor digitorum brevis and quadratus plantae muscles of the foot. These trigger points are typically quite tender to pressure. Their pain referral is to the bottom of the foot, particularly to the heel.
When not mislabeled plantar fasciitis, heel pain is often falsely blamed on heel spurs. Heel spurs can be present and actually not be the cause of the pain. Indisputable evidence of the harmlessness of a heel spur is when trigger point therapy stops the pain.
Trigger points in the soleus muscles of the calves are the primary cause of heel pain, and therapy by means of self-applied massage is amazingly simple, quick, and long-lasting.
Doctors Travell and Simons point out that the eleven muscles of the lower leg are actually foot muscles. Anatomists call them “extrinsic” foot muscles, meaning they operate from outside the foot. The muscles in the foot itself are “intrinsic” foot muscles, meaning they work from inside the foot.
The implication of these facts is that foot pain may not be coming from the feet themselves, but may be referred pain from trigger points in muscles of the lower leg. You can waste a lot time rubbing and soaking your feet, if your foot pain is coming from somewhere else.
The tibialis posterior, a very deep muscle in the calf, is the true source of the disabling pain and stiffness in the back of the ankle so often mistakenly labeled Achilles tendinitis. Interestingly, trigger points also weaken this muscle, allowing your ankle to turn inward and making it appear that you have fallen arches.
In Travell and Simons’ view, “tendinitis” is largely a wastebasket diagnosis, employed when the true cause of the problem isn’t clearly understood. Pain in or near a tendon is almost always simple referred pain from trigger points in associated muscles.
Trigger points should be at the top of the list during any examination for pain, numbness, and other abnormal sensations in the lower legs, ankles, feet or toes.
When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself quite effectively. Indy Myopain Relief Center will teach you to treat yourself as part of our self care program.
A trigger point in the tibialis posterior muscle, which is the most common cause of pain in the back of the ankle, so often misdiagnosed as Achilles tendinitis.
Trigger points in other lower leg muscles cause pain in the toes, arches, heels, and the front of the ankles.
When plantar fasciitis is prolonged, it is known to reduce blood circulation around the plantar fascia, and subsequently cause a thickening of the plantar fascia. Previous studies [15,37] noted that ESWT revitalizes tissues by increasing angiogenesis and nitric oxide mediated anti-inflammatory effect, which thereby decreases the thickening of the plantar fascia by stabilizing inflammation. ESWT promotes faster healing of muscles, tendons and fascia.
Indy Myopain Relief Center is Indy's number one Trigger Point Therapy Center with two of the three nationally certified Trigger Point Therapists. (CBMTPT.org) in Indiana. Our staff has received additional training with Stew Wild, Katie Adams and Sharon Sauer.
We are Indy's only Trigger Point Therapists that combine Travell's muscle rehabilitation protocols with Extracorporeal Shock Wave Therapy (ESWT) to provide the midwest's most advanced pain relief and muscle rehabilitation capabilities. Trigger Point therapy eliminates the stress and referred pain of distant muscles pulling on the fascia of the feet. We know of no other therapy that works more effectively. We do this without medicine or surgery. Plantar Fasciitis relief can be accomplished in 1-6 treatments. And it lasts!
Contributors: Amber Davies (CMTPT) and Steve Maschmeyer (CMTPT)