The first few steps hurt in the morning

Most people have experienced aches and pains in their foot, but once a person develops chronic foot pain even the simplest activities can become intolerable. The most common reason a person develops foot pain is plantar fasciitis.  In fact, it’s estimated that plantar fasciitis effects up to 2 million Americans every year. It’s also been reported that plantar fasciitis will affect approximately 10 percent of the population over the course of a lifetime.  Unfortunately, this painful condition effects both the very active and sedentary. In most cases the pain experienced will usually prevent a person from running or performing their favorite recreational activity.  In severe cases a person may only be able to walk for a brief period of time without resting.

The plantar fascia is a structure located at the bottom of the heel bone that travels up to the toes.  Its main function is to help maintain the arch of the foot.  Plantar fasciitis can develop as a result of overuse (i.e. an avid runner), if a person has an unusual spike in activity level, or if a person experiences excessive weight gain. Plantar fasciitis can also develop from age related changes to the plantar fascia.  Most people complain of sharp pain under the heel that is usually worst in the morning, and usually the first steps taken in the morning are the most painful. A person will also complain of discomfort after long periods of inactivity.  A classic example of this is sitting for hours at an office while at work and then getting up to go to lunch.  Usually mild activity such as walking will reduce a person’s symptoms.  Runners are at greater risk of developing plantar fasciitis and people who stand for prolonged periods of time and individuals who are obese are at greater risk as well.
A physical therapist will first conduct a thorough evaluation to determine if the patient has plantar fasciitis and if they have any range of motion or strength deficits.  The therapist will also examine how the patient walks to determine if they have developed any compensation patterns which are perpetuating their condition or if they would benefit from orthotics.
Along with orthotics proper footwear is required to prevent and minimize a person’s symptoms.  In order to relieve excess tension on the plantar fascia sneakers with additional arch support should be worn.  If a person is extra sensitive around the heel they may also required a sneaker with additional padding at the heel.  The vast majority of sandals do not provide proper arch support or padding and because of this they should not be worn by a person who has plantar fasciitis.  It’s important to note whether or person is experiencing foot pain or not a runner should only go for brief runs with new running shoes and gradually increase their mileage in order to break in the new shoes and to prevent foot related injuries.  Because of the importance of footwear, during the initial examination the patient should bring the shoes they wear throughout the day and the shoes they wear when performing exercise.
After the initial examination a physical therapist will then prescribe exercises that stretch the calf and also the plantar fascia. This has been shown to consistently aid in reducing the amount of heel pain in patients with plantar fasciitis. In order to improve the effectiveness of these stretches the physical therapist will also perform a deep tissue massage on the plantar fascia which will further stretch the plantar fascia.
The therapist will also instruct the patient on how to utilize a massage ball. This will decrease any built up tension in the plantar fascia. The therapist will also educate the patient on the importance of icing which will reduce any inflammation. Ultrasound will also be incorporated to help increase blood flow to the plantar fascia which will accelerate the healing process.  The physical therapist will also tape the ankle and foot which will provide extra support for the arch and increase the patient’s ability to weight bear on their foot with less pain.
People who develop plantar fasciitis often will have increased tissue tension in their calves and this usually causes trigger points to form.  Trigger points in the calves often refer pain down towards the bottom of the heel and foot and can contribute to the pain the patient is experiencing. This is due to the fact that the calves’ tendon (Achilles tendon) and the plantar fascia both connect to the heel bone.  As a result, when there’s an increase in tissue tension in the calves this will place more tension on the Achilles tendon which indirectly stretches the plantar fascia which can cause very small tears to form and this can lead to additional inflammation and pain. To reduce the patient’s heel pain the physical therapist will employ hands on techniques to release these trigger points.
As the patient begins to progress the therapist will also begin introducing weight bearing exercises (such as squatting and plyometrics) which will allow the patient to return to more functional and physically demanding tasks such as running or their favorite sport. Although millions of Americans struggle with plantar fasciitis it does not mean that you have to resign yourself to a less active lifestyle.
If you have been experiencing foot pain and its affecting your quality of life take action, contact Total Performance Physical Therapy for an evaluation today.

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