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calcaneal tuberosity, where the nerve can be compressed against the bone or bone spurs that may have developed along the anterior calcaneus due to plantar fasciitis or some other cause. MUSCLE-TENDON PATHOLOGY Another potential source of plantar foot pain is strain, trigger points, or dysfunction in the muscles and tendons on the plantar surface of the foot. There are two broad categories of muscles to consider in this region: extrinsic and intrinsic. Extrinsic muscles originate outside the foot and include the muscles of the deep posterior compartment that have tendons coursing under the bottom surface of the foot. These are the fl exor hallucis longus, fl exor digitorum longus, and tibialis posterior (Image 2). Intrinsic muscles have both ends of attachment within the foot complex. This group includes the interosseous and lumbrical muscles and the quadratus plantae (Image 4). Let's look at these two muscle groups. The Extrinsic Muscles All three extrinsic muscles course around the medial side of the ankle as they pass under the fl exor retinaculum in the tarsal tunnel (Image 2). One common cause of foot and ankle pain in these tendons is friction and irritation of the tendons in the tarsal tunnel. In addition to tarsal tunnel irritation, problems may occur with these tendons on the plantar surface of the foot. Scar tissue from tendon irritation or plantar fasciitis may cause the tendons to adhere to each other. Adhesion between these structures may be evident if there is a significant clawing of the other toes when the f lexor hallucis longus is activated during attempted f lexion of the great toe. The Intrinsic Muscles The intrinsic muscles are short muscles with both attachment points within the foot. As noted, this group includes the lumbricals, interosseous muscles, and quadratus plantae, among others. Because these muscles are so short, they aren't often strained because their size doesn't allow excessive lengthening while under contractile load. However, strains are possible in these muscles. A strain to one of these short intrinsic foot muscles could easily be mistaken for something more common, like plantar fasciitis or tarsal tunnel syndrome. The foot is under extreme compressive loads, especially during repetitive lower extremity athletic activities like running and jumping. Improper footwear, lack of conditioning, excessive overuse, or numerous other factors could lead to hypertonicity or the development of myofascial trigger points that would produce plantar foot pain. Other factors, such as shoes with very high or deficient arch support, may alter foot biomechanics to the point that these muscles become painful due to overuse or trigger-point development. CONCLUSION While these are not the only causes of plantar foot pain, they are some of the most common. As noted, plantar foot pain can be a debilitating problem, and clients will often seek your help in resolving this complaint. Luckily, soft-tissue therapies like massage can play a signifi cant role in reducing painful symptoms and returning to full function. In the next installment of this series, we'll examine key principles and techniques for effective treatment. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 25 TECHNIQUE 4 Intrinsic foot muscles. Image courtesy of Complete Anatomy. Lumbricals Quadratus plantae ABMP CE COURSE FROM WHITNEY LOWE AND TIL LUCHAU: "PLANTAR FOOT PAIN" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Learn!