Hippocrates, the father of medicine, has been quoted as saying, “For many problems, look to the spine.” The chiropractic profession has used this quote for a long time, but for many patients it seems too much of a stretch to apply it to pain in the foot.
But health problems are usually not as simple as we like to think. Many patients have told me that seemingly unrelated problems resolve when the spine is corrected, such as digestive problems, headache, even asthma. They can accept that, because the problem is right nearby. But foot pain?
The key is in the medical name for foot pain, plantar fasciitis. “Plantar” means the bottom of the foot, the “itis” means inflammation, and the “fasci-” is for fascia, or connective tissue. Fascia travels everywhere in the body, connecting bones, muscles, and organs and basically holding us together. It has the dual functions of supporting our structure, while allowing stretch and movement.
A common cause of pain is a tightening of the fascia, which prevents its normal free, easy movement. Often fascia is restricted in a whole region (say, from the low back to the foot) but the pain and inflammation are only felt in one place (the bottom of the foot). Of course, the opposite can also be true; in the same situation, with tightening of the fascia from the back to the foot, the pain may be felt at the low back. Another patient may complain of knee pain, yet another complains of pain throughout the whole leg or even a “restless leg” type symptom.
That is the problem with only treating a patient’s symptoms with drugs or surgery — the underlying issue is often pretty complicated. Obviously, patients benefit from treatment wherever there are restrictions, not just at the painful site. Only getting a shot or surgery to the foot will not always address the whole problem. Fascial tightening is related to problems in the joints and muscles, where a tight muscle or misaligned joint can affect the local fascia, and tight fascia can affect them in turn.
I have seen cases where foot pain was blamed on a heel spur, yet removing the spur did not help as much as treating the spine. Plenty of patients with heel spurs get complete relief when their tight fascia is treated.
Tight fascia can be treated several ways, and each approach has its benefits; many patients require more than one to get fully better. A common treatment is stretching. For some patients this works well, but for others it should not be started until after the patient has been loosened up and the inflammation reduced. Manipulation is a better starting treatment for most patients, as it is less likely to further inflame the tissues. Acupuncture can also be very effective at relaxing tissues and releasing fascia; this is true of both needle acupuncture as well as electro-acupuncture, in which the point is stimulated without any needles.
The bottom line? A few people won’t get relief until their heel spurs are removed, or their fascia are treated surgically. But not everybody benefits from that treatment, and most don’t need to have such an aggressive approach, especially at first. In treating foot pain it is best to start with the least invasive, more holistic approaches that include checking and treating the whole fascial track.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.