Chronic Foot Pain May Not Be Plantar Fasciitis

Chronic Foot Pain May Not Be Plantar Fasciitis

by | Jun 2, 2025 | Ask The Expert

Q: I’ve had six months of physio and orthotics for Plantar Fasciitis — but I’m still in pain. Can you help?

A: Maybe you’re not dealing with true Plantar Fasciitis — and yes, I can likely help.

If you’ve been diligently foam rolling, stretching, or wearing orthotics for half a year without significant relief, it’s time to consider another explanation for your foot pain.

Plantar Fasciitis is defined as micro-tearing and inflammation of the plantar fascia — the thick connective tissue running along the sole of the foot. It typically causes sharp pain in the heel or arch, especially with the first few steps after rest. Common causes include poor footwear, hard walking surfaces, repetitive strain, and foot structure issues. But here’s the catch:

Many cases of “Plantar Fasciitis” are misdiagnosed. And misdiagnosis = mistreatment.

Why Treatment Often Fails

While some foot pain is indeed caused by plantar fascia overload, many other sources can mimic its symptoms. Most notably: myofascial trigger point referral pain from the lower leg.

Here’s what many treatment plans overlook:

➡️ Every muscle between your knee and ankle has tendons that insert into the foot.

➡️ If those muscles are tight, dysfunctional, or weak, they may create pain in the foot — even if the foot itself isn’t injured.

Focusing treatment solely on the plantar surface (i.e., rolling the foot or icing the heel) ignores the muscular contributors higher up the chain. For true resolution, we must assess both ends of the muscle — and everything in between.

The Real Culprits: Trigger Point Referral Patterns

According to the pioneering work of Dr. Janet Travell, trigger points in specific muscles often refer pain into the sole of the foot. These patterns are well documented in about 90% of the population. Some people feel sharp pain; others feel tingling, numbness, or deep ache.

Here are some of the most common muscular contributors to foot and heel pain:

  • SOLEUS – Refers pain to the bottom of the heel (think: gas pedal action)
  • GASTROCNEMIUS – Refers to the arch of the foot
  • FLEXOR DIGITORUM LONGUS – Refers to the arch via toe flexion (gripping)
  • FLEXOR HALICUS LONGUS – Refers pain to the ball of the foot and possibly arch
  • TIBIALIS POSTERIOR – Can refer pain throughout the entire sole of the foot
  • PERONEUS TERTIUS – May refer pain under the heel and up the back of the leg

Treatment Strategy: Smart, Not Scattershot

You have two main options:

1. Shotgun Approach:

Treat all suspect muscles and hope you hit the right ones.

2. Assessment-Driven Approach (My Recommendation):

Start with orthopaedic testing and resisted muscle actions to identify which muscles are weak, tender, or reproduce the foot pain when engaged. This tells us exactly where the dysfunction lies — and helps prioritize treatment.

We’ll also palpate tendon attachment points, where chronic adhesions often build, and combine this with targeted manual therapy (myofascial release or silicone cupping — not aggressive trigger point work). The goal: release, realign, and reactivate.

What You Can Expect From Care:

✅ Muscle testing to pinpoint the origin of your foot pain
✅ Soft tissue treatment that targets the entire kinetic chain
✅ Customized home care including:

      • Glute strengthening (hip extension + abduction)
      • AIS stretching for hip flexors
      • Gait re-education for walking and running mechanics

What If There’s Still No Change?

If pain persists after a structured trial of soft tissue therapy, it’s time to revisit the diagnosis. Ask your physician about diagnostic imaging to investigate:

  1. Osteoarthritis
  2. Joint hypermobility
  3. Structural foot conditions

…but don’t skip the muscle work first. In many cases, what seems like a chronic joint issue is actually referred muscular dysfunction — and very treatable.

 

BOTTOM LINE:
If you’ve been treating “Plantar Fasciitis” for months with no improvement, it’s worth asking: is it really the fascia at all? Effective recovery starts with better assessment — and ends with targeted, whole-chain treatment that actually works.

Serving Okotoks, Calgary and surrounding area. Book an initial orthopaedic assessment & treatment session today to uncover the real cause of your foot pain.

Hip, Knee and Foot Pain Connection

Hip, Knee and Foot Pain Connection

by | Mar 4, 2025 | Ask The Expert

Q: I’ve had persistent issues — first with my hip, then my knee, and now my foot. What’s going on, and can massage therapy help?

A: Yes — and you’re likely dealing with a kinetic chain dysfunction that started in the hip.

When pain or dysfunction begins in one area and then “travels” over time to other joints or regions, we call this a kinetic chain issue. In simpler terms, the body is compensating for an unresolved problem upstream — and eventually, those compensations become their own problems.

One of the most common patterns I see in my clinic today — especially among people who spend long hours sitting — is the hip-to-knee-to-foot pain cascade. Let’s break it down.

Step One: Assess the Hip First

Your hip function is the foundation of lower body movement. If your hip flexors are chronically shortened from sitting and your glutes are weak or misfiring, your body will try to compensate — often by over-recruiting the hamstrings, particularly the lateral hamstring (biceps femoris).

This imbalance has a ripple effect:

  • Tight hamstrings rotate the tibia (shin bone) improperly aka tibial torsion

  • The patella (kneecap) starts to track laterally

  • The fibular head (on the outer knee) becomes fixated, losing its ability to pivot with knee movement

That last detail is key. Every time you bend your knee, the fibula should rotate slightly outward — like a saloon door swinging open. When this movement becomes restricted, it disrupts the biomechanics of the entire lower leg.

Eight Muscles Pay the Price

There are eight key muscles in the lower leg that attach to the fibula and its connecting interosseous membrane. These include muscles like:

  • Peroneus longus and brevis (ankle evertors)

  • Flexor hallucis longus (big toe flexor)

  • Tibialis posterior (arch support)

  • Soleus and others

All of them play critical roles in ankle mobility, foot stability, and gait mechanics. When the fibula is restricted, these muscles become overworked, irritated, and dysfunctional — which may explain your foot pain even if the foot itself was never injured.

Treat the Root Cause, Not Just the Symptoms

In this pattern, the hip dysfunction would have likely triggered compensation at the knee and foot. Treating only the knee or foot without addressing hip mechanics is like bailing water from a sinking boat without plugging the leak.

  • Start with orthopaedic testing to assess hip flexor overuse and glute weakness

  • Use myofascial release to improve mobility in the hips and legs

  • Restore proper glute function with activation and strengthening strategies

  • Address secondary restrictions at the knee and foot once the primary driver is corrected

What If the Glutes Are Fine?

If testing shows your glutes are firing well and your hip isn’t the source of dysfunction, we’ll shift gears and pursue other orthopaedic assessments to pinpoint the true origin. It could be structural (joint), neuromuscular (firing pattern), or fascial (tissue restrictions).

Either way, this is where integrative, assessment-driven massage therapy shines — because we don’t guess. We test, treat, and re-test.

BOTTOM LINE:

Don’t chase the symptoms. If you’ve had a domino effect of pain from hip to knee to foot, it’s time to take a whole-body approach. In most cases, resolving the original hip dysfunction unlocks the entire chain — and gets you back to pain-free movement faster.

If are in the Okotoks or greater Calgary area and you’re ready to get to the root of your hip, knee, or foot pain, please visit the CONTACT ME page to book an assessment and start your personalized treatment plan.