While a small minority of us springs out of bed once the alarm rings, majority of us dread to get out of bed – who’s with me here? It is a pain to get out of bed in the morning, but what’s worse: when the heel touches the ground, it shoot pain from the foot right up your spinal cord into the brain and “OUCH” you go!
Yes! Especially the first few steps in the morning…why is that so?
Well, the culprit is most likely the plantarfascia. It is a thick fibrous band, shaped like a bowstring, that connects the heel to the ball of the foot. Its main function is to support the arch of the foot and provide shock absorption when we walk.
It also has a close relationship with the calf muscles through fascial connections – meaning reduced tissue mobility and muscle extensibility of the calves may also contribute to the onset of plantar fasciitis or plantar fasiopathy.
When we sleep at night, the foot is relaxed in a slightly pointed position, we call it plantarflexion, which keeps the plantar fascia and calf muscles in a shortened position for a prolonged period of time.
The first few steps in the morning is especially painful is likely due to the sudden and excessive stretch on the plantar fascia as we load it full on with our body weight. The pain caused by this sudden need to stretch and bear load may also occur with standing after prolonged sitting.
Plantar fasciitis is a common repetitive strain injury. Some factors may increase the risk of developing this condition. They include:
- Footwear: If you run or walk a lot in poorly fitted shoes or shoes without arch support.
- Activity type: Long-distance runners, ballerinas or people whose job requires them to stand all day. Also, if you decide to go for a long run or join a high intensity exercise class with heaps of plyometric exercises when you’ve been a couch potato for an extended period of time, good luck.
- Foot type: Unfortunately, both high arch and flatfoot may increase the risk of having plantar pain. Since this condition is likely an overuse injury, folks having normal arches may not be spared.
- Body weight. Having a BMI of >30kg/m has 5x more risk than someone with a BMI of <25kg/m. Once again, since it is likely to be an overuse injury, weight does increase the load that our structures have to take. Sorry, but shedding the kilos does help with our physical health in many ways.
- Reduced muscle extensibility and mobility of the calf muscles. The calf muscles are made up of the gastrocnemius, soleus and plantaris. Tight calf muscles may contribute to plantar pain due to the fascial connections – the calf muscles blends into the Achilles’ tendon and, continues to the plantar fascia. Reduced tissue mobility may also affect the energy transfer down the kinetic chain thus predisposing one from having persistent or recurrent heel pain.
I’ve been having heel pain for many years, I even have a heel spur!
These bony spurs occur in 10-20% of the population and they look like an obvious culprit for the cause of your heel pain. The bony spur is the calcification of the plantar fascia – an indication that it is an area of high load! Your body is laying down calcium deposits to cope with the stress that you are putting through it.
In fact, it is usually the plantar fascia or other soft tissues that may be causing the pain rather than the bone itself. Most importantly, there are people out with bony spurs but does not have heel pain! Therefore, it is not indicative for the need to have it surgically removed. Having the bone spur removed surgically does not guarantee resolution of your pain.
If the loading pattern stays, the spur will grow back again.
Oh No…I don’t want my mornings to be more painful than the need to get out of bed.
The good news is, the body is very adaptable – it’s ability to take load can be improved through careful progression. First, let’s “fix” the morning foot pain. These are some things you can do before stepping down onto the floor to help manage the pain:
- Flex and point your foot. Pull your ankles back until you feel a gentle stretch in your calves then point your toes to relieve the tension. Repeat this until you feel less tight in your calves (up and down, approximately 20x).
- Sitting, flex foot and extend the first toe. This will help to stretch out the plantar fascia, hold it for 30s, do it 3 times.
Now that you are up and going, the following may be helpful in terms of managing your pain:
- Foot wear. Wearing thick-soled bedroom slippers at home and insert a silicon heel cushion into your shoe may help to cushion the heel from the ground reaction forces. Ensure that that your foot wear provides sufficient support for your physical activities.
- This is a temporary solution to help off load your arch.
- There are muscles that you can strengthen to help offload the plantar fascia; namely the foot intrinsics as well as the tibialis posterior. Remember the plantar fascia’s connection to the calf muscles? Stretching the gastrocnemius and soleus muscles may help too.
Ideally, you should check in with a Physiotherapist as delaying treatment to heel pain can be quite a pain and affect other joints down the kinetic chain. We can provide advice for footwear and teach you taping techniques to help manage the pain. Different foot types may require a slightly different set of exercises. Here is a snapshot of what else physiotherapy treatment can offer:
- Shockwave therapy: this treatment uses mechanical energy to target the injury. In cases of chronic plantar fascia pain, the pain comes from scarring and hardening of the planar fascia. Scarring occurs with repeated injury to the same spot and shockwave is useful to soften and target the scarring.
- Standing, walking and postural correction: we will analyse your posture in various activities. You could be unknowingly hammering on your poor plantar fascia when we stand or walk. All these biomechanical errors can be due to our lifestyle, footwear and habit. Correcting these is super essential to prevent recurrence.
Overall while Dr Google can give you a wide array of exercises to do, a Singapore physio will be able to teach you to do them correctly and advice how to progress your exercises and activities to mitigate the risk of causing your plantar fascia to get angry with you again.