Endurance Running: A Look at Anatomy, Foot Pain and the Plantar Fascia

Most of the the runners and running groups in my neck of the woods are training for the Whistlestop full or half marathon in Ashland, WI. As a massage therapist who specializes in pain relief and improved range of motion, many of my patients and friends who run ask what I would recommend for the treatment of foot pain, heel pain and plantar fasciitis. Left untreated or caught too late, many have had to dial back on their training because of unchecked pain and inflammation. I wanted to use this post to talk about the anatomy of the lower leg, and share some techniques that people can use.

One of the most common complaints I hear of in runners is pain on the bottom of the foot, near the heel, or plantar fasciitis. People are often surprised to hear that the problem isn't always where its felt. I mean, yes, the fascia is tearing off the heel bone, but it is usually started with a problem further up the kinetic chain. In fact, by working directly on the plantar fascia, the problem seldom goes away. While I do work on the foot, so much of the heel pain is improved by a serious calf treatment. I try to lengthen the gastrocnemeus and other calf muscles with very specific and precise manual muscle manipulation.

In the illustration, you can see that the more superficial calf muscles merge into the achilles tendon which in turn attaches to the calcaneus, or heel bone. (The deeper calf muscles also attach to the calcaneus after wrapping around the medial ankle.) You can almost see the big strong gastrocnemeus and soleus,  the deeper muscles, and the surrounding fascia, getting too tight and pulling up on the heel. What if over time, the soft-tissue of the calf became adaptively shortened or "gummed-up" and ended up in a tug-of-war match with the plantar aponeurosa  at the front of the calcaneus? The action of the calf muscles is to pull the heel up, but the action of the plantar fascia is to stabilize the arch. The next image shows the bottom of the foot and its muscles. You can see where the plantar fascia attaaches on the sole of the foot at the heel. If it was involved in a tug-of-war  with the calves, which muscle would win? Where is the most likely place for strain to occur? No wonder it can feel like its ripping apart off the heel!

Quite often, by restoring the posterior compartment (calves) of the leg to a more normal resting length, the strain is taken off the bottom of the foot. If you are seeking medical massage for treatment of heel pain, be sure to also have your therapist check your pelvic angle as a tight rectus femoris (one of the quadriceps) or other hip flexors may also contribute to this problem recurring (but that's another can of worms for another day). Right now, here are a couple of videos that you, both runners and other massage therapists, might enjoy watching. This first video is Douglas Nelson treating a patient who has plantar fasciitis. Doug is the founder of PNMT, the method that I use most often to treat painful conditions.
 http://www.youtube.com/watch?v=QDRMVGH33pQ

I also like Erik Dalton's anatomical description of the foot and plantar fascia in this one:
http://www.youtube.com/watch?v=8bh5I50q5ck

If you are involved with a running group in Ashland, Washburn, or Bayfield, WI, I teach a workshop covering anatomy of the foot and leg, as well as sports massage techniques you can do with a partner to help keep the calf muscles loose.

Run strong!
Gina