A Hidden Cause of Heel Pain - NOT Plantar Fasciitis

If you have been diagnosed with plantar fasciitis, you likely know it is inflammation of the long, thick band of connective tissue on the bottom of the foot called the plantar fascia. Inflammation of this fibrous support ligament is considered the most common cause of heel pain. Though heel pain is the most common complaint of plantar fasciitis, pain can manifest anywhere along the plantar fascia ligament, such as the arch or under the ball of your foot.

Certainly plantar fasciitis is often a direct source of heel pain. However, it's just as likely that all or part of your heel pain may be coming from from a trigger point in the soleus muscle of your calf.

There are a few muscles with specific points in them that can refer pain to the
foot, heel and plantar aspect (sole) of the foot. These points are, aptly enough,
called trigger points (TPs). The most frequent offender for heel pain is one of
three TPs in the soleus muscle of the calf and it is our our focus here.

The most well-known and heavily relied upon medical textbooks for trigger point theory and treatment are by Janet G. Travell, MD and David G. Simons, entitled Myofascial Pain and Dysfunction, The Trigger Point Manual in Volumes 1 and 2.

Janet Travell coined the term "trigger point" in 1942 her first published medical journal article on the subject. Dr. Travell continued her innovative, pioneering work for the next 50 years, culminating in the publication of the second volume of Myofascial Pain and Dysfunction. By the time of the second volume appeared, the significance of trigger points in painful conditions, initially a controversial subject, had become firmly established and respected by even formerly skeptical clinical investigators. She became the White House Physician after successful treatment of President Kennedy in 1955 that enabled him to continue his politcal career. Dr. Travell remained the White House Physican through the Johnson administration.

At the time of publication of the second volume of The Trigger Point Manual, Dr. David G. Simons, a research scientist and former aerospace physician, had worked with Dr. Travell for 30 years. Together they further studied, tested and mapped trigger points and came to understand more about the neurophysiologic mechanism involved. As a result, today we have their effective clinical methods of treatment for the common but very complex pain problems of trigger points and referred pain.

Many very good doctors have not been trained in the details of myofascial pain and dysfunction and will not be aware that one little sore spot in the calf muscle can either cause or perpetuate heel pain. There is plenty of information around on plantar fasciitis, but little about the pesky trigger point (TP) in the lower soleus muscle that, even in spite of the best plantar fasciitis treatment, will keep your heel in pain.

The lowest trigger point in the soleus muscle (part of the calf) is our culprit and you can identify its location with the X in the illustration.

There are two other major trigger points in the soleus muscle, however, rather than referring pain to the heel, one causes pain in the calf and the other refers pain to the sacroiliac area of the low back. If, along with heel pain, you also suffer from pain in the calf or very low back, these other two TPs are something you may want to investigate further.

The two kinds of Trigger Points (TPs) are Active and Latent.

An active TP will be easy for you to find, if you have one. Pressing the TP (see the red "X" in the picture above), and if it is active, it will be tender and when pressed, if it refers pain to your heel, it is definitely active. You will likely also notice that your lower leg muscles feel tight.

Latent TPs aren't easy to identify if you haven't had training. However, they do cause tightness in the involved muscle. Latent TPs can be found by a trained therapist and should be eliminated as they can cause continuing problems.

If you pursue therapy, be sure to verify that the therapist is trained in myofascial trigger point therapy. You can check the therapist's knowledge by asking what muscle can get a Trigger Point that refers pain to the heel. If the therapist does not know that it is the soleus muscle, continue on until you find a savvy therapist, as this is basic knowledge in myofascial TP therapy.