Written by: Lindsay McGuire, MS, CSCS, PT, DPT

In recent months I have had an increasing number of lifters approach me with heel pain during their squat and during other times of the day. I have noticed this heel pain is more common for those who walk out their squats and for those lifters who also participate in cross-training activities for cardio or other purposes that require repetitive pounding on their feet such as running. In almost every case, other than a select few, I have diagnosed them with plantar fasciitis.  Plantar Fasciitis is more common in runners than lifters. However as powerlifters are becoming more well-rounded athletes, this particular condition has started to pop up and can be pretty painful and debilitating if not treated.

What is the plantar fascia and what does it do?

The plantar fascia is a thick band of tissue that stretches from the heel to the toes as shown below. 

 

The plantar fascia is a shock-absorbing material in which supports the arch of your foot. Just like any other material in the body, if this is strained too much, it can become inflamed and in some cases, small tears or even a full tear can occur.

What are the symptoms of plantar fasciitis?

• Stabbing pain usually in the heel first thing in the morning
• Stabbing pain after sitting or standing for long periods
• Pain may decrease after increased movement
• Stabbing pain in heel while walking out your squat
• May also have pain after repetitive movement 

What causes this?

Repeated wear and tear on this tendon is what causes the inflammation. However, poor mechanics over a long period of time will lead to the inflammation. With the cases I have treated, the most common cause has to do with increased pronation during activities. Pronation is the foot caving in while it is bearing weight as shown below. 

When your foot goes into pronation, it stretches the plantar fascia causing increased tension and stress on the tissue. There are several reasons why this may happen. The first may be due to weak ankle inverter muscles that run on the medial aspect of the lower leg whose main job it is to keep the ankle from collapsing. Among those is a muscle called the Tibialis Posterior. This muscle inverts the ankle, plantar flexes and supports the medial longitudinal arch of the foot which allows the foot to stay in a neutral position while weight bearing. If this is weak, the foot may have a decreased arch and increased pronation causing increased pressure on the plantar fascia.

The next culprit may be due to a tight gastroc/soleus complex which represents the muscles that make up the calf. These muscles primarily perform plantar flexion of the ankle. I have found that many lifters have tight calves which can also increase the strain put on plantar fascia because of changes in mechanics while weight bearing due to compensatory strategies.

The last major contributing factor may be weak hips. When hip abductors are weak, this causes a medial rotation of the femur which then subsequently causes a medial collapse or pronation of the ankle.  See below. 

Exercises to fix this:

1. At night, gently roll your foot over a frozen water bottle making sure you roll from the very end of the heel to the toes. This will help to stretch out the fascia and also decrease inflammation due to the ice.  Do this for about 5 minutes 1x day. See below.

2. In the morning, if you have time, roll your foot overall ball several times before taking your first step. If not, perform this throughout the day to keep the fascia stretched out. This can be a golf ball, tennis ball etc. Do this for 5 minutes 1-2 x day. See below.

 

3. Plantar Fascia stretch: sit with one leg crossed over the other. Grab your big toe and extend it while dorsiflexing your foot.  Perform 2-3 x day for 30-60 seconds. See below.

4. Gastroc/Soleus stretch: For gastroc stretch, keep back leg extended and heel on the ground. For soleus stretch, keep back heel on the ground and let knee bend until you feel a stretch. Perform 2-3 x day for 30-60 seconds. See below.

5. Strengthening your Inverters: Use a theraband or no resistance at all. Place band wrapped around the inside of your foot and slowly bring your foot medially without rotating your entire leg. Perform 1-2 times per day for 15-30 reps.

6. Clamshells: to strengthen your hip external rotators to decrease medial rotation. Lay on your side. Keep your heels together and rotate your knee up towards the ceiling. Do not rotate your trunk with it. Perform 1-2 times per day for 15-30 reps. Can add more resistance with the band around knees if needed.  See below.

7. The last item I usually recommend to people if they are still struggling to decrease their pain is to buy a Strassburg Sock to wear at night. This helps to keep your foot in dorsiflexion and great toe into extension as most people tend to sleep in a plantar flexed position. 

If you are having heel pain as described as above, try these three simple items for 2-4 weeks. If your pain does not decrease or worsens you may consider seeing your primary care physician or local physical therapist to further address these concerns. If any of these exercises cause pain do not continue to perform as this may indicate that these are not appropriate for you.

 

References: 

1. Understanding Plantar Fasciitis https://http://www.fairview.org/patient-education/83735.
2. https://http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846.
3. What is Pronation? Definition, Causes & Treatment https://study.com/academy/lesson/what-is-pronation-definition-causes-treatment.html.
4. The Key to Fix Bow Legs: The Pelvis https://http://www.straightlegsblueprint.com/key-fix-bow-legs-pelvis/.
5. Eliminate Heel Pain https://eliminateheelpain.com/massage-therapy-for-plantar-fasciitis.
6. LTD Commodities https://www.ltdcommodities.com/Apparel---Beauty/Health---Beauty/Plantar-Fasciitis-Massage-Balls//prod1170363.jmp
7. Why is my heel sore when I get out of bed? What can I do?  http://semrc.blogs.latrobe.edu.au/heel-sore-get-bed/.
8. Running with Hayes.  http://www.runningwithhaynes.com/2012/10/12/stretching-routine-for-runners/.
9. Tibialis Posterior https://http://www.google.com/search?q=strengthening+tibialis+posterior&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiohKjcxojYAhWpzIMKHa1iBCcQ_AUICigB&biw=1363&bih=682 - imgrc=T2qnNPQ7ijSXUM:.
10. Be Beautiful

             https://http://www.bebeautiful.in/lifestyle/health-and-fitness/5-exercises-to-help-tone-your-butt.

11. Strassburg Sock.  https://thesock.com/helps/.  .