Managing your foot pain

Most people associated foot pain with the diagnosis of plantar fasciitis. Which, in some cases may be true, but its particularly hard to self diagnose based purely on the pain being in your foot. In fact there are many structures that need to be considered. 

This blog aims to provide insight about the complex structure of the foot and other structures which should be considered in diagnosis. Then I'll share with you my tips for self-management options. 

Possible cause of foot pain?

Location of the pain is not a specific identifier of the source of the problem. Lets take a look at the structure of the foot for a moment. 

Bones in the foot are subject to bruising and stress fractures. Just looking at the pictures below, it can be said that pain through the medial arch could be possibly coming from the head of the talus, the navicular, the cuneiforms, and the 1st metatarsal. These are the bones which comprise the medial longitudinal arch of the foot. 

With so many bones making up the brilliant and complex nature of the foot, its very hard to pinpoint one structure based on location of pain.

Bones of the foot (Cleland, 2005, p. 337-338). 

Plantar fascia is a thick structure lying at the base of the foot. It is not a muscle. It acts to provide a fascial connection from the toes to the base of the heel. Below the plantar fascia is where all the magic happens. Did you know there are four layers of muscles in the base of the foot? Lets take a quick look at those layers (I don't want this to become an anatomy lesson but really just show you how beautifully complex the foot is). 

Muscular dysfunction in Tibialis posterior, Extensor hallusis longus, Extensor Digitorum longus, Peroneals. 
These are the names of the muscles which live in the lower leg (above the ankle) and have long tendons extending down into the foot to create active slings which help control the arches of the foot and the movement of the toes. Having these muscles strong and functioning well together is crucial for controlling the position and function of the foot. If they fail to do their job in controlling the arches, the bones in the foot, ligaments and intrinsic muscles will be over-loaded. So foot pain can be a result of dysfunction higher up the chain. 

(Cleland, 2005, p. 346)

Restricted ankle dorsiflexion resulting in poor biomechanics. 
Dorsiflexion is the movement of flexing your ankle towards your head. Dorsiflexion comes from the ankle and is controlled by the calf muscles and shin muscles. If you have a stiff ankle or weak muscles then when you land in running there is going to be less shock absorption through the ankle, which will increase ground reaction forces in the foot, knee and higher up the chain. Having a stiff ankle might also make it more likely for the knee to track medially and the arch to collapse on landing as a compensation for more range and shock absorption. 

Hopefully this highlights a few different considerations in the diagnosis and treatment of 'foot pain', a non-specific term describing only the location of symptoms and not the cause or predisposing factors. Hopefully you're starting to think "How do you know if its the bones, muscles, joints above the foot, or running technique which is contributing to your problem?"

Honestly, that is too difficult to answer in a blog as everyone is different, their technique is individualised to their body type and context of training. I'd advise a musculoskeletal assessment. But as promised in the introduction, here are some exercises which are really important to do well and can help a lot to get the basics correct. 

Calf length

The calf and underlying smaller muscles in the lower leg have a huge impact on the development and recurrence of heel and foot pain. Why? Because the calf controls the position of the ankle joint at the point of impact and slows down body weight during the landing phase of running and stores this energy to allow for propulsion into the swing phase. 

If your calf is tight, weak or painful, it can impact on the quality of muscle contraction and the control of ground reaction forces passing up through the leg. 

Test your calf length in 2 positions. The first is with a straight knee (to test gastrocnemius) and the second is with a bent knee and flat heel (to test achilles and soleus).

There are many ways which you can stretch your calves. The key tips are to stretch with both a bent and straight knee, and to focus having correct foot & knee alignment to get the best stretch. What that means is that sometimes a deviation can occur seen by the medial arch collapsing, the ankle rolling inwards and the knee drifting inwards over the 1st toe and medial arch. 

Other self-treatment options

Self-treatment options can include calf stretches (as above), foam roller & spiky ball massage, and calf strengthening. Lets take a look ...

One aspect of treatment not covered in this blog is lower limb kinetic chain rehabilitation and gait retraining. As explained earlier, there is probably an aspect of faulty biomechanics, leg weakness, overtraining, or footwear issues that lead to the development of  the problem in the first place. The internet is a great source for tips and information but it can also get overwhelming and over-saturated with ideas. What you need is information specific to your problem and for this I'd recommend a musculoskeletal assessment. 

My goal for writing this blog was to provide information that might enhance or supplement the your current knowledge and give you a few tips for self-management strategies.

Sian 

Cleland, J. (2005). Orthopaedic clinical examination: an evidence-based approach for physical therapists: WB Saunders Co.