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.
Misdiagnosis of Plantar Fasciitis
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.
Examples of Pain Referral
Most of the familiar pain in your arches comes from trigger points in the gastrocnemius muscle of the calf. These same trigger points cause calf cramps.
Pain in the toes frequently comes from trigger points in the flexor digitorum longus and extensor digitorum longus muscles of the lower leg. The extensor hallucis longus muscle in the front of the lower leg is the most common cause of pain in the big toe joint that is so often misdiagnosed as gout.
When your feet hurt at the end of the day, it may not be foot massage that you need, but lower leg massage!
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’s 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 Point Therapy
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. Here's a sample from the book:
The illustration shows 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.
The illustration on the right shows massage of the calf with the opposite knee. Use the weight of the leg to apply pressure.
The trigger point in the tibialis posterior is about a third of the way down from the knee. It's very deep, right on the back of the fibula, the outermost bone in the lower leg.
Six to twelve short strokes across the trigger point make a treatment, but treat several times a day.
Using 375 illustrations, The Trigger Point Therapy Workbook shows you dozens of “guerrilla tactics” like this that you can use in your war against common pain. This is an example of how easy, quick, convenient and inexpensive this “war” can be.
In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies has simplified Travell and Simons’s extensive research into myofascial pain and made it accessible to the layman. His innovative methods of self-applied trigger point massage will relieve pain in the lower legs, ankles, and feet when trigger points are the cause.
To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.