Symptoms:

• Sharp pain in the bottom of the heel.
• Pain is usually most intense in the morning or after sitting for prolonged periods. The tissue shortens while we are not on our feet, and when we then stand and apply forces onto the foot, it stretches the fascia and pulls at the insertion point (calcaneal tuberosity) on the bottom of the heel.
• Pain often worsens after activity, not necessarily during activity.

Possible Causes:

• Poor Foot Biomechanics: Pronation is a necessary function of the foot. Pronation allows the foot to disperse shock and provide stability to the joints of the foot. However, overpronation is an excessive amount of pronation, in which the arch collapses with each step. Overpronation can cause the foot to flatten out and the plantar fascia to pull more at the insertion point on the heel, which over time can cause irritation. Conversely, if the foot does not pronate enough, due to either a rigid foot or an overly supportive shoe or insert, it might not allow for proper shock absorption and may stress the rigid tissues of the foot.

• Improper footwear: If you overpronate, your arch tends to collapse as you walk or run. Putting a medial arch support under your foot doesn’t allow the foot to flatten, which leads to less stress on the insertion point on the heel. If you have a rigid foot, you may want to avoid shoes that are overly supportive and don't allow adequate pronation to occur. Being in a shoe that does not match the shape of your foot can cause your foot to hang off of the platform or have too much extra room inside the shoe. Both of these can lead to excessive movement and stress the Plantar Fascia.

• Overuse: Whether you are on your feet all day at work or just starting an exercise program, it is likely that the plantar fascia will be stressed more than usual. As you are on your feet longer, the foot will tend to flatten out due to fatigue. It can also be more stressful on the feet if you are on hard surfaces.

• Tight calf muscles: ou have two calf muscles (Gastrocnemius and Soleus) which connect to your Achilles tendon. The main jobs of the calf is to plantar flex the foot (push off on your toes) and stabilize the lower leg when the foot is on the ground. The Achilles tendon attaches on the back of that heel bone. If the calf muscles are too tight, they will pull on the Achilles tendon, increasing the stress at the insertion point on the heel bone and causing it to become irritated and inflamed.

Self treatment options:

• Support: With extreme pain, make sure that you wear shoes with a supportive medial arch at all times and avoid going barefoot as much as possible, even when you are walking around the house. You might consider adding removable insoles (i.e. Stabilites, Orange Insoles, Powersteps) to shoes you currently have that might not be supportive enough. Shoes with rocker bottoms have been shown to significantly reduce plantar fasica stress and pain. Remember that supportive options are only temporary remedies and stretching and strengthening are very important for long term treatment and recovery.

• Calf stretches: It is important to not only stretch the muscles and tendons on the bottom of the foot, but also to address the tight calf muscles. See below for Gastrocnemius and Soleus stretches.

• Foot stretches: Massaging the foot and calf with a tennis ball, Foot Rubz, massage ball, or foam roller will help loosen the tight muscles and fascia fascia.

• Strengthening: Once the pain dissipates, it is important to strengthen the foot to prevent the symptoms from returning. See the reverse side for pictures of suggested exercises.

• Single leg balance, toe scrunches, ankle alphabets.

• Rest: “Play it by pain” – use pain to dictate your level of activity.

• Free Clinics: Most people walk and run in a way that puts excessive braking and friction on their joints, muscles and tendons. Take a FREE Good Form Running and/or Good Form Walking clinic to have your form analyzed! Our Stretch, Strengthen, and Roll class will cover common muscle imbalances and how to correct them.

• Products: Insoles, Foot Rubz, Trigger Point Therapy massage ball, Addaday roller, Plantar Fasciitis compression sleeve or socks, Pro-Tec Night Splint, Strassburg Sock

Note: We always recommend seeing a physician or attending our Injury Clinic on Wednesdays from 5:30-7:00pm for more information.

Exercises

Calf Stretches:

Gastroc: Stand with your right foot back. Keep your knee straight, and forward leg bent. Keeping your heel planted on the floor, toes facing straight ahead, lean forward from the ankles toward the wall. Hold for 30 seconds, and then switch legs

Soleus: Stand with your right foot back. Put a slight bend in your back knee, and forward leg bent. Keeping your back heel planted on the floor, toe facing straight ahead, lean forward from your ankles toward the wall. Hold for 30 seconds, and then switch legs.

Dorsiflexion with Resistance Band:

Tie one end of a resistance band to a stationary object and the other to your forefoot. Dorsiflex the foot by slowly pulling the forefoot toward your shin. Hold for 3-5 seconds and slowly let the band pull the foot back to a plantarflexed position. Repeat 15-20 times per foot multiple times per day. Progress by using a stiffer band, performing the movement more slowly, and dorsiflexing the toes throughout the exercise.

Single Leg Balance:

Balance on one foot for 30 seconds while barefoot. If this is too easy, close your eyes and tilt your head back! Advance to single leg squats by bending your knee, being sure it does not drift to the inside and the hips remain level.

Foam Roll:

Begin with the roller on the achilles and perform circular motions with your foot, 3x each direction. Then slowly move up the calf by progressing 2" up, 1" back, so you are doubling over. Stop to perform the foot circles on any sore spots.

Ankle Alphabets:

While seated, write the alphabet using your foot and ankle motions A → Z. Progress to perfoming these exercises standing on one foot

Rolling out Plantar Fascia:

Helps promote recovery by increasing circulation and flexibility. Loosens the foot flexors that pull the big toe in. Could be done before or after exercise and throughout the day.

Doming:

To help increase intrinsic foot muscle strength and arch stability, this exercise is like a plank for your foot. Leaving the toes and heel on the ground, feel like you are pulling your arch up and back, towards your heel. You should still be able to see the tops of your toes. Hold for five seconds. Repeat as many times as possible throughout the day. To progress difficulty, move to doing this while balancing on one foot.

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