Jogger’s Heel (Plantar fasciitis)

• Overview
• Symptoms
• Onset
• At risk behavior and activities

• Soleus
• Gastrocnemius
• Hamstrings (secondary)

• Calf Muscles
• Hamstrings

Pain in the foot and heel afflicts thousands of people all around the world every day...the second they step foot out of bed. This throbbing and painful condition is what stops the routines of many athletes as well as routines of those who use exercise to reduce stress and maintain well being. The good news is there are techniques which may be applied to the foot, calf, and thigh which may be very helpful in relieving this painful condition.

Symptoms

The symptoms of plantar fasciitis are as follows:

• Pain and stiffness in the calf, heel, and foot when getting out of bed in the morning. The pain usually gets better after         a few steps, but then gets worse as the day wears on.
• Pain after standing for long periods.
• Pain from climbing steps.
• Pain when exercise begins and then gets better with movement, only to return at the end of the session.

Onset

Onset of the condition is typically gradual with pain occurring on the inner heel. On occasion the onset will be sudden, but this is usually after an injury such as missing a step, a jump, or any type of unaccustomed forceful or sustained contraction.

Activities which are most likely to cause or aggravate the pain of plantar fasciitis are:

• Exercises which work the calf muscles (calf raises, stair climber, etc.).
• Sleeping on the back in a bed with tight sheets as the tight sheets will keep the toes pointed and the calf muscles          contracted all night.

Identifying the Muscular Components of Plantar Fasciitis

Let us first look at how the muscles of the body can cause pain and dysfunction. According to specialists in the field of myofascial pain, there are 4 major causes of pain from the muscular system.

Muscle tension comes from not working off the stresses of life and is one of the most common reason for chronic pain. Because the muscles are staying tighter than normal the muscles actually begin to cut off their own circulation and place additional pressure on surrounding nerves and eventually irritating them.

Muscle spasm is when a muscle contracts strongly and won’t let go. This is what is usually responsible when a person says their “back went out”.

Muscle weakness is a part of both muscular tension and spasm. Underexercised muscles may contribute to much, if not all, of pain supposedly caused by arthritis.5

Muscle trigger points are small tender nodes of degenerated muscle tissue which develop as a result of prolonged spasm or tension and have the ability to send pain to areas distant to their location. Theses trigger points need to be addressed first as any type of strengthening tends to make pain from trigger points worsen.

Assessing yourself and applying self treatment

I would first like to say, as a therapist, any person who is attempting to run this protocol without at least consulting a professional who is familiar with muscle syndromes is taking somewhat of a risk of misdiagnosing themselves. Notable doctors and therapists will help you learn to treat yourself properly and once you understand what needs to be done, you will be able to apply self treatment during flare ups down the road and circumvent therapy since you won’t need it. We advise to interview potential doctors and therapists to be sure they will not make you a “professional patient”. One of the only things worse than being in chronic pain is being a chronic pain patient!

There are several components of the myofascial system which can directly affect the amount of strain placed on the plantar fascia. First, the plantar fascia itself can become tightened and inflamed, thus causing pain. Muscles of the calf (gastrocnemius and soleus) can also cause tightness which pulls on the plantar fascia and causing pain. Also, trigger points can develop in the gastrocnemius and soleus which refer pain into the calf, ankle, and inner heel and foot. Another muscular component is the hamstrings because of the pull which can be placed on the calf muscles which in turn pull on the plantar fascia.

Notice how this condition can relate all the way into the hamstring muscles. A person who decides to treat this condition on themselves should look to treating everything we just mentioned. Once these areas begin to loosen up, a noticeable change in pain should be noticed.

Self Treatment

Plantar fascia

The plantar fascia is located on the bottom of the foot. Direct compression and massage of the bottom of the foot may be accomplished in many ways. One of the easiest ways of doing this is by using a self treatment tool, called the Knobble II. The Knobble is recommended over a golf ball because it may also be used on the calf muscles in the next section. To self treat, simply place the Knobble on the floor with the pointed side upwards and place the foot on top. Apply pressure to locate the extremely tender aspects of the foot and, once found, hold the pressure until the pain subsides or reduces. You may then compress a little harder which will increase the pain again. Compress until the pain subsides again. Do this three times in the same spot to break through the pain barriers. After working one spot you may move to find another and repeat the procedure until the foot is covered. We recommend doing this while watching television as you will not have to take extra time out of the day to self treat.

		Calf muscles (gastrocnemius and soleus) Self treatment may be applied by using the Knobble to compress the muscle bellies of the calf muscles. Start from the bottom of the leg (near the Achilles tendon) and work upwards. If you find a spot which refers pain into the foot then hold that spot until it reduces in pain. Then compress again to increase the pain and hold until the pain subsides again. Do this three times on the same spot and then stretch the calf muscle(s) as seen in the diagrams below. Work the calf muscles in this way up to the knee and stretch again. Application of moist heat, via a Thermophore, is recommended to bring more blood to the area and restore proper circulation.
Soleus	Gastrocnemius

Hamstrings

The hamstrings may already be well loosened from the work which has just been done on the plantar fascia and calf muscles. In case they are still tight they may be easily worked on with an Acu-Masseur to compress the muscles and a Thermophore to bring blood back to the muscle. The hamstrings may then be stretched using a variety of different stretches. 

Once full range of motion is restored to these regions of the body, the majority of pain should be gone.