Plantar Fasciitis and Running, Why It Hurts
Why does my foot still hurt after I got a Cortisone Shot?
Very often stubborn cases of Plantar Fasciitis will not resolve with repeated injections of cortisone. It is usually seen as a last ditch effort to stop the pain. One reason the injections are not effective is because the pain originates higher up in the leg.
The gastrocnemius muscle at the back of the leg has two heads. If you were to probe the back of your leg below the knee you would feel significant tenderness and pain if you had plantar fasciitis. This is usually where the starts to show. The muscle becomes dysfunctional here and starts to tighten and pull on the insertion point on the bottom of the feet.
The abundant nerve supply in the foot allows for a great deal of pain as we stand and go through our daily routines. Now add running into the equation and you have just ramped up the pain and have added further dysfunctionality. .
Plantar Pain in your foot starts somewhere else
The problem begins long before you feel plantar pain
The reason the gastrocnemius becomes dysfunctional is because of tension that can begin in the pelvis. The femur attaches to the pelvis and uneven wearing of the pelvis causes the iliotibial band along the outside of the leg to contract on one side. This puts added stress on the fibula actually pulling it upwards. This interrupts the normal knee anatomy relationship between the fibula, tibia and femur. The added stress will force the muscles to tighten to support the structures.
The extra work load placed on the knee joint gets transferred to the gasctrocnemius and it will spasm eventually. The nerve supple to the gastrocnemius in more heavily weighted to motor function so it is not as sensitive as the small muscles of the feet.
You won't know there is a problem building up in the gastrocnemius because it lacks the nerve sensitivity to warn you of a problem.
Graston Technique Performed on Calf Muscle
Why Injecting Cortisone Locally Won't work
The problem of plantar fasciitis is that it is global. It affects the entire motor unit of the lower extremity. Beginning with the trunk flexors, in the abdomen. The trunk flexor group begins in the abdomen at the base of the rib cage and it inserts onto the pelvis. When stressed the trunk flexors will pull the pelvis out of place.
The pelvis then has un-even pull placed on one side. This un-evenness causes the femur to mis-align. The tension is transferred to the knee complex. The uneven force gets translated to the gasrocnemius. The gastrocnemius puts stress on to the plantar surface causing the plantar fasciitis pain. A shot to the pain site ignores causative factors further up the lower motor unit.
That is why cortisone is not effective in treating plantar fasciitis. The real target is further up in the leg. relieve the tension there and you will be better equipped to address the painit is causing further down the leg.
Where to look for the causes of plantar fasciitis
1- Look at the trunk flexor muscles Iliopsoas and iliacus
2- Look for tightness in the iliotibial band running down the side of the leg.
3- Feel the gastrocnemius muscles located behind the knee. You will fell painful nodules throughout the leg into the foot.
4- Check for tightness near and around your Achilles.
5- If none of the above are sore or tender then cortisone should work well for your plantar pain.