Quadratus Plantae Trigger Points

Introduction

The quadratus plantae is a deep foot muscle responsible for assisting toe flexion and stabilizing the foot arch. When trigger points develop in this muscle, they can cause heel pain, arch tightness, and foot cramping, often mimicking plantar fasciitis, Achilles tendinitis, or tibial nerve compression.

Name and Area

  • Name: Quadratus Plantae (Flexor Accessorius)

  • Area: Located in the sole of the foot, running from the calcaneus (heel bone) to the tendons of the flexor digitorum longus.

Indications

Quadratus plantae trigger points may contribute to:

  • Pain in the Heel and Arch (Mistaken for Plantar Fasciitis or Heel Spurs)

  • Pain That Extends to the Toes (Can Mimic Nerve Compression or Metatarsalgia)

  • Tightness or Cramping in the Foot After Walking or Running

  • Pain When Pressing on the Heel or Sole of the Foot (Common in Runners and Those Who Stand for Long Hours)

  • Weakness in Toe Flexion (Can Affect Pushing Off When Walking or Running)

  • Foot Fatigue or Discomfort That Worsens with Unsupportive Shoes or Barefoot Walking

Pain from this muscle is often mistaken for plantar fasciitis, Achilles tendinitis, or foot nerve compression.

Muscle Action

  • Assists in Toe Flexion: Helps the flexor digitorum longus in bending the toes downward.

  • Supports Foot Arch Stability: Helps maintain foot posture and proper weight distribution.

The quadratus plantae is crucial for foot mechanics, arch support, and lower limb function.

Signs and Symptoms

Individuals with quadratus plantae trigger points often report:

  • Pain in the Heel and Sole That Worsens with Standing or Walking

  • Pain or Cramping in the Arch and Toes After Long Walks or Runs

  • Pain When Pushing Off the Toes or Standing on Tiptoes

  • Tightness or Fatigue in the Foot That Feels Like "Walking on a Rock"

  • Pain That Worsens with Barefoot Walking or Wearing Unsupportive Shoes

  • Discomfort That Is Worse in the Morning or After Periods of Rest (Similar to Plantar Fasciitis)

Pain worsens with prolonged standing, walking, or using unsupportive footwear.

Perpetuating Factors

Common causes of quadratus plantae trigger points include:

  • Running or Walking Long Distances Without Proper Foot Support (Common in Marathoners, Hikers, and Athletes)

  • Wearing Unsupportive Shoes (Flip-Flops, High Heels, or Shoes with Poor Arch Support)

  • Flat Feet or High Arches (Can Lead to Overuse of the Foot Muscles for Stability)

  • Excessive Barefoot Walking on Hard Surfaces (Increases Strain on the Foot Arch and Heel)

  • Standing for Long Hours on Hard Floors (Common in Retail, Hospitality, and Healthcare Workers)

Trigger Point Referral Pattern

Trigger points in the quadratus plantae refer pain to:

  • The heel and plantar arch (Can Mimic Plantar Fasciitis or Heel Spurs)

  • The ball of the foot and toes (Mistaken for Metatarsalgia or Nerve Pain)

  • The Achilles tendon and lower calf (Can Resemble Achilles Tendinitis or Posterior Tibial Dysfunction)

Pain from this muscle is often confused with plantar fasciitis, nerve entrapment, or foot arch dysfunction.

Differential Diagnosis

Quadratus plantae trigger points may be mistaken for:

  • Plantar Fasciitis (Heel and Arch Pain, Worsens in the Morning or After Prolonged Standing)

  • Tarsal Tunnel Syndrome (Nerve Compression That Causes Burning or Tingling in the Foot and Ankle)

  • Achilles Tendinitis (Heel and Lower Calf Pain, Worsens with Running or Walking)

  • Metatarsalgia (Pain in the Ball of the Foot, Worsens with Weight-Bearing Activities)

  • Posterior Tibial Dysfunction (Arch and Heel Pain, Often Due to Weak Foot Stability Muscles)

A thorough foot, ankle, and lower leg examination is necessary to rule out these conditions.

Associated Trigger Points

Quadratus plantae trigger points often co-exist with:

  • Flexor Digitorum Longus (Toe and Arch Pain, Affects Foot Stability and Push-Off Strength)

  • Tibialis Posterior (Inner Ankle and Foot Pain, Affects Arch Support and Stability)

  • Peroneus Longus and Brevis (Outer Foot and Ankle Pain, Can Affect Balance and Gait)

  • Gastrocnemius and Soleus (Calf Tightness and Heel Pain, Can Contribute to Foot Fatigue and Instability)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Quadratus Plantae Medial and lateral sides of the calcaneus (heel bone) Tendons of the flexor digitorum longus Lateral plantar nerve (S1–S3)

The quadratus plantae is innervated by the lateral plantar nerve, which also controls toe movement and foot stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the heel, arch, and lateral plantar surface.

  • Resisted Toe Flexion Testing: Assess pain and weakness when curling the toes downward against resistance.

  • Gait Analysis: Look for excessive pronation, foot instability, or difficulty maintaining balance while walking.

  • Ankle and Foot Arch Testing: Rule out ligament sprains, nerve compression, or metatarsal dysfunction.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the quadratus plantae, reducing foot tightness and improving arch stability.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the plantar arch and heel.

  • Massage Therapy: Helps improve circulation and reduce muscle tension in the foot arch and heel.

Stretching

  • Toe Stretch and Foot Arch Stretch: Pull the toes back while keeping the foot relaxed to loosen the plantar fascia and intrinsic foot muscles.

  • Calf Stretch Against a Wall: Helps reduce tension in the Achilles tendon and foot arch muscles.

Strengthening Exercises

  • Toe Gripping Exercises: Strengthens the quadratus plantae and foot stabilizers.

  • Resistance Band Toe Flexion: Improves toe control and push-off strength.

  • Short Foot Exercise: Helps activate the arch and improve foot stability.

Postural and Footwear Adjustments

  • Wear Shoes with Proper Arch Support (Prevents Excessive Strain on the Foot Muscles)

  • Use Custom Orthotics If Needed (Provides Better Foot Stability and Reduces Heel Pain)

  • Avoid Walking Barefoot on Hard Surfaces for Extended Periods (Prevents Excessive Foot Muscle Overuse)

Conclusion

The quadratus plantae plays a crucial role in toe flexion, foot arch stability, and lower limb function, but trigger points in this muscle can cause significant heel, arch, and foot pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic foot dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.