Confusing Nomenclature and Trigger Point Therapy
The usual term “plantar fasciitis“ is used in this article too; as its cause, a “mechanical reaction to overloading with many contributing factors” is stated (1)—I think that is correct. In my opinion, the suffix “-itis” should only be used for conditions clearly caused by inflammation or at least with a primarily inflammatory component, even though the English medical terminology is not so strict in this respect. Otherwise, these conditions will continue to be regarded and treated as being related to a lack of cortisol—or non-steroidal anti-inflammatory agents.
With regard to the etiology, it would be interesting to know whether the prevalence of the condition is lower in countries where people usually walk barefoot. If so, it could be assumed that the symptoms are (also) caused by overloading and subsequent hardening of the foot and calf muscles due to hard soles of shoes, which would fit with the onset of pain after rest and then after prolonged exertion.
With regard to treatment: In patients with clear association of the condition with shortening of the calf muscles, stretching exercises and, if necessary, gastrocnemius release surgery are recommended. Treatment of myofascial trigger points accomplishes efficient and lasting release of the shortened muscles in a gentler way (2). This does not only apply to the triceps surae muscle, but also to the quadratus plantae muscle which is often involved.
Dr. med. Nicolas Behrens
Facharzt für Physikalische und Rehabilitative Medizin, München, Germany
Conflict of interest
Dr. Behrens received fees from Elsevier for the publication of the book “Leitfaden Triggerpunkte“. He receives fees for continuing medical education from the Deutsche Ärztegesellschaft für Akupunktur and the Kneipp-Ärztebund.
|1.||Gutteck N, Schilde S, Delank KS: Pain on the plantar surface of the foot. Dtsch Arztebl Int 2019; 116: 83–8 VOLLTEXT|
|2.||Irnich D: Leitfaden Triggerpunkte. München: Urban & Fischer/Elsevier 2017; 728–37.|