Painful First Steps in the Morning?

Do you step out of bed in the morning and hobble? Are you having a sharp pain or ache in the bottom of your foot? Has it continued to get worse instead of better?

Typically what is causing your discomfort is called plantarfascitis. There is a fascia on the bottom of your foot that gives support to the muscles of your foot. This fascia is attached to your heel bone (calcaneus) which is where your achilles tendon attaches as well. Achilles tendon then attaches to your calf muscles (gastrocnemius and soleus). Usually, this is an overuse injury, change in footwear, or sometimes it just happens. It can be quite uncomfortable and debilitating if not taken care of properly.

In the above picture, the foot has many different aspects. There are multiple bones along the middle of your foot that can become stiff which can lead to decreased mobility in your foot with walking. This can change the way you strike the ground and roll to your toes. All of this can affect the musculature and the tendons/fascia in your foot. If those structures, have more tension on them it causes inflammation at their insertion point. This inflammation then lets the body know something is wrong and that it needs to inform you, thus the sensation of pain.

As you can see in the above picture, the gastrocnemius muscle has two muscular heads, one medial (inside) and one lateral (outside), with a much longer tendon. In the picture they refer to the achilles tendon as the calcanea tendon. The picture, on the right shows the gastroc muscle peeled away exposing the soleus muscle. It is a broad fan like structure. The action of both of these muscles is to plantarflex your foot, or point your toes down. If you were to do a calf raise, these are the muscles that are allowing you to do so.

The above picture breaks down the musculature and fascial components of the foot. As you can see in the picture on the left, the plantar fascia makes up the majority of the bottom of your foot and your arch. It is made up of fibrous tendons. There are muscles that lie on either side as well as underneath. The anatomy of the foot has many different aspects, but they all need to work together in order to work properly. As you can see from the pictures, there are many structures that pass over, under, or between muscles or tendons. This increases the chance of dysfunction. Tightness can wreck havoc on it all.

In my experience as a Physical Therapist and Athletic Trainer, the calf musculature is the culprit most of the time. Yes, the plantar fascia can also be tight or have trigger points. However, loosening the calf musculature plays a major role in the recovery process. The first exercise I typically give patients experiencing this is a calf stretch. I tell them to perform it up to 10 times a day, 3 sets for 30 seconds. The more the musculature is stretched and loosened, the less tension that is being applied to those tendons.

3 for 30 seconds, knee straight and knee bent. Goal is 10 times a day.

The picture above illustrates two types of calf stretches I like to give to patients. The one on the left stretches the gastroc muscle that is smaller and sits on top of the soleus. The one on the right, stretches the soleus muscle which is longer, wider and sits underneath the gastroc muscle. The stretch on the right has the patient bending their back knee as opposed to the one of the left where the back knee is straight.

Know anyone suffering from the pain described throughout this post, have them tune in on Friday for more stretches and strengthening exercises to decrease their pain and improve their function.

Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.