2299 W. Grand River Ave. Okemos, MI 48864 517-349-3803 www.playmakers.com

Heel Pain (Plantar Fasciitis)

Description: Inflammation (-itis) of the connective tissue (fascia) on the bottom of the foot (plantar). The plantar fascia originates on your metatarsal heads and inserts on the calcaneus (heel bone). The function is to support the arch and act as shock absorber for the foot. 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. 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 causes the foot to flatten out and the plantar fascia pulls more at the insertion point on the heel, which over time can cause inflammation. Conversely, a high rigid arch might not allow for proper shock absorption of the foot and may stress the rigid tissues of the foot. • Improper footwear: If you are an overpronator, your arch tends to collapse as you walk or run. By putting a medial arch support under your foot, it doesn’t allow for the foot to flatten, which causes less stress on the insertion point on the heel. When the foot wants to naturally flatten, the arch support won’t let it. By maintaining the proper foot alignment, it will also allow for better alignment in the knee, hips, and low back. If you have a high rigid arch, you may require a softer shoe to help absorb the shock to the foot. • 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 also can be more stressful on the feet if you are on hard surfaces. • Tight calf muscles: You have 2 calf muscles (gastrocnemius and soleus) which form your Achilles Tendon. The main job of the calf is plantar flexion (push off on your toes) and stabilize the lower leg when we land. The PF and AT attach to the same heel bone (calcaneus). If the calf muscles are too tight, they will pull at the insertion of the Achilles tendon, which in turn will stress the tissues on the bottom of the foot and the insertion point of those tissues on the bottom of the heel. • Age: There is a decrease in the elasticity of tissue as we age. As the tissue tightens up, there is more pull at the insertion point on the calcaneus Other considerations: • If your foot pain is in the medial arch, it is not necessarily plantar fasciitis. Pain in the arch is more indicative of Posterior Tibial Tendon Dysfunction (PTTD). The PTT attaches from the inside of the tibia (shin bone) to the medial arch bones of the foot (navicular and cuneiforms) and plays a major role in supporting the foot. If you have PTTD, it could lead to collapsing of the medial arch and overpronation of the foot. • When someone experiences long-term (chronic) Plantar Fasciitis, the stress on the insertion point of the calcaneus could lead to a Heel Spur (a bony protrusion diagnosed by x-ray). Often times, conservative treatment of the Heel Spur is very similar to the treatment for Plantar Fasciitis. • Adolescents that develop heel pain are likely experiencing Calcaneal Apophysitis (known as Sever’s Disease) rather than Plantar Fasciitis. There is a growth plate in the heel that can become inflamed with activity, tight muscles, growth spurts, or improper footwear. (See Sever’s Disease injury article) Note: If Plantar Fasciitis is not properly treated, it could lead to an eventual heel spur. We always recommend seeing a physician or attending our Injury Clinic on Wednesdays from 6-8pm for more information.

Self-treatment options: • Support: Make sure that you wear shoes with a supportive medial arch at all times. 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. • Stretching: • Calf stretches: It is important to stretch 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, or massage ball will help loosen the 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. • Ice: this might help reduce some inflammation and help with pain control. Fill a water bottle with water, freeze it, take it out and roll your bottom of the foot over the bottle for 8-10 minutes about 3-4x/day • Be patient and consistent: treating Plantar Fasciitis can be a long slow process. Be consistent with the recommendations and you should start to notice improvements with 3-4 weeks. • Products: Insoles, Foot Rubz, Trigger Point Therapy massage ball, Addaday roller, Plantar Fasciitis compression sleeve or socks, Pro-Tec Night Splint, Strassburg Sock

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

PLANTAR FASCIA STRETCH: Seated, pull your toes up to put the bottom muscles of your foot on stretch. You may use your thumb to massage the fascia and muscles while they are being stretched.

SINGLE LEG BALANCE: Balance on one foot for 30 seconds while barefoot. If this is too easy, close your eyes!

TOWEL SCRUNCHES: Lay a towel out on the floor. Flex your toes to grab the towel, then scrunch it towards you. Repeat until the entire towel gathered. Spread the towel back out and repeat.

CALF RAISES: Stand on the edge of a step, stand tall with your abdominals pulled in, balls of your feet firmly planted on the step and heels over the edge. Raise your heels above the step so you’re on your tiptoes. Hold that position, then lower your heels below the step, feeling a stretch in your calf. Repeat 10x.

TOE FLEXION AND EXTENSION: Push your big toe into the ground, while lifting your 4 smaller toes. Hold for 3-5 seconds, then push your 4 smaller toes into the ground while lifting your big toe off the ground. Repeat 10x each foot.

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