Description/Introduction:

A sharp pain or discomfort in the heel on weight bearing especially after a rest period is a common complaint. It settles down quickly if treated early and given enough rest, but may become worse and chronic if initial symptoms are ignored.

COMMON CAUSES OF HEEL PAIN:
Heel pain can be either due to plantar fasciitis or heel spur syndrome.

Plantar fasciitis is felt as a pain around the heel and arch of the foot. It can be felt as a discomfort or sharp pain in the heelon weight bearing especially after a rest period. As a person gets older, the fascia becomes less elastic. The heel pad becomes thinner and loses the capacity to absorb as much shock. There may be some swelling, small tears or bruises in the plantar fascia with the pounding force on the heel. Plantar fasciitis can also be a result of overuse in activities such as long-distance running, basketball, ballet dancing or dance aerobics. It settles down quickly if treated early and given enough rest, but may become worse and chronic if initial symptoms are ignored.

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To reduce the pain of plantar fasciitis, try these self-care tips:

• Give adequate rest to your feet.  Avoid prolonged standing or high impact activities like running that cause repeated loading on the foot. If you need to stand for long time,then shift your weight from one foot to the other or use a footrest under the affected foot to offload it for a while.
• Don’t walk barefoot, especially on hard surfaces, as this puts extra stress on the plantar fascia. It is advisable to wear soft heeled footwear or footwear with scooped out heels to avoid pressure on the heel.
• Wear supportive shoes. Choose shoes with a low to moderate heel, supportive arches and good shock absorbency.
• Avoid high heels especially when you need to walk long distances or stand for long periods of time. High heel shoes exert additional pressure on the inflamed fascia and lead to more heel pain.
• Do not wear worn-out shoes. Replace old, tattered, non-supportive shoes. This is very important if you walk or run in these shoes. A good way to tell that your shoes need replacing is to look for thinned (worn) out areas on the sole of the shoe.

• Apply ice: This can be done on the painful area three or four times a day, especially at the end of the day. Icing helps to reduce pain and inflammation. Icing can also be done with a frozen bottle of water rolled under the foot while sitting.
• M assage: Self massage can be done by rolling a tennis ball under your foot while sitting. As mentioned above, a frozen water bottle can also be used.

• Change your sport. Try a low-impact sport such as swimming or bicycling instead of walking or jogging while the plantar fascia is inflamed/painful.
• Maintain a healthy weight. If you are overweight, then try to lose some weight.  Extra weight can put extra stress on your plantar fascia.
• Exercise before getting out of bed in the morning or after prolonged sitting (sit to stand): Plantar fasciitis pain is usually at its worst in these two situations. A good way to combat this is to perform circular movements at the ankle (clockwise and anticlockwise) and a few seated calf stretches before weight bearing on the feet.
• Do your stretches. Simple home exercises can be done for plantar fasciitis. Perform this stretch when waking up, mid-day, and before bed. It is also very important to perform these stretches in the warm up and cool down phase of your exercise routine, even after you recover from plantar fasciitis pain. This will help to prevent any recurrences. 

1. Standing calf (gastrocnemius) muscle stretch:

• Stand on the edge of a step (stairs) or stable stool
• Lower one heel over the edge of the step
• You should feel the stretch on the calf muscle.
• Hold stretch for between 12-15 seconds, 3-5 repetitions each side.

2. Seated calf stretch:

• Sit with your legs extended out in front of you and then bring your foot in towards you from the ankle at about 90 degrees.
• You can get an additional stretch by using a towel or yoga belt and placing it around the ball of the foot.
• You can either stretch one calf at a time or both together.

3. Soleus Stretch:

• To stretch place the leg to be stretched behind and lean against a wall, keeping the heel down
• A stretch should be felt lower down near the ankle at the back of the leg
• Hold for 12-15 seconds, 3-5 repetitions each side.

4 . Stretching the deep foot flexors

• In sitting position, gently hold foot with one hand
• With the opposite hand pull all five toes up towards the body
• Hold for 12-15 seconds, 3-5 repetitions each side.

5. Towel lifts

• This is to strengthen the deeper muscles of the foot (intrinsic muscles)
• Place a hand towel on the floor. The towel should be completely flat
• Stand with your foot over the towel and use your toes and the bottom of your foot to scrunch up the towel
• Next use your toes and feet to flatten the towel
• Repeat 10 times, 2-3 times daily 

Description/Introduction to Flat Foot:

Flat foot/overpronation is a condition characterized by downward collapse or flattening of the arch of the foot. During normal walking, an inward rolling of the foot (pronation) occurs naturally. This helps to absorb shock and maintain alignment of the ankles and legs. However, in overpronation, the foot moves excessively downward and inward and the arch flattens with each step, thereby causing stress and strain on the soft tissues (ligaments, muscles) surrounding the ankle. It can also cause compensatory changes in the hip and knee, which can lead to increased risk in sustaining lower limb injuries.

Flatfoot can either be congenital which means you are born with the flat feet or it can be acquired later in life.

Risk Factors:

• uneven leg length, 
• knock knees,
• being overweight,
• pregnancy, and 
• prolonged standing, walking or running on hard surfaces.
• Also, middle-aged women were found to be most commonly affected and the risk is known to increase with age.
• In children, conditions such as cerebral palsy and Down syndrome were both known risk factors.

1. Dynamic ankle mobilization

Goal: Increase mobility of ankle joint.     

• Place one foot flat on a table or a hard surface.
• Bend your hips and knees forward until the end- range.
• Do this 10 times for 3 sets and repeat on the other leg

2. Arch Setting Exercise

Goal: Strengthen the muscles that maintain the arch of the foot.

1. Sit with feet flat on floor
2.  Push your big and second toes down to raise your arch and hold it or 5 seconds repeat 10 times for 2 sets.

Note: *Maintain contact of toes and heel on the floor while raising your arch. *DO NOT curl your toes.

4. Calf Raises with Tennis Ball

Goal: Strengthen Calf and Tibialis posterior (maintains the arch) muscles

1. Stand with feet shoulder width apart, and put a tennis ball in between your ankles
2. Perform calf raises by standing on toes while holding the tennis ball in-between the ankles
3. Slowly return to starting position or eccentric strengthening of the muscles

Do this 10 times for 3 sets

5. Static Gastrocnemius stretching

Goal: Stretch Gastrocnemius muscle

1. Stand with your arms leaning on the wall in front of you.
2. Step the leg that you want to stretch behind with feet flat on the ground, knee straight and toes are facing forward.
3. Slowly lean and shift your weight forward, allowing your front knee to bend while keeping the back knee straight.
4. Hold the position or 15 seconds and repeat 3 times on each side

6. Static Soleus stretching

Goal: Stretch Soleus muscle

1. Stand with your arms leaning on the wall in front of you.
2. Step the leg that you want to stretch behind with feet flat on the ground, knee straight, toes are facing forward (12 ‘clock).
3. Slowly lean and shit your weight forward, allowing your front and back knee to bend until stretch is felt.
4. Hold the position or 15 seconds and repeat 3 times on each side.