 Christine Lenders, certified orthopedic clinical specialist. I have here joining me today. My co-host, Little Richie, he joined me in physical therapy school and helped me learn everything that I need to know. So today, we're going to be talking about Achilles tendonitis and plantar fasciitis, and you are going to learn the number one reason why you get these painful foot and ankle conditions. So Achilles tendonitis and plantar fasciitis are very painful conditions. It involves how we walk. It's something that we do every day, walking upstairs, getting out of bed, walking down the hall. If you're an athlete, you're running, you're jumping, you're playing, you're going up and down hills to get through your daily life, and this pain makes it very difficult to go day to day. Let's go to video number one to learn more about plantar fasciitis. It seems that pretty much everyone at some point in their life will have plantar fasciitis, especially that's what I'm seeing in the clinic nowadays. People are walking more and trying to get more exercise outside, and so we're seeing biomechanical faults contributing to pain on the bottom of your feet. The plantar fascia is a tissue that runs right underneath here. It's like a tendinous fascial kind of tissue, and what it helps to do is stabilize this arch. Now I have a very high arch. Some people's arches are very flat, but the reason why, the main reason why people get plantar fasciitis is they don't have enough range of motion in their ankle this way. You're supposed to have about 20 degrees from the 90 degree position, the L, the L. You're supposed to have about 20 more degrees of ankle range of motion when you walk, when you go up and downstairs, when you run, and most people that I see tend to have about zero, or just that 90 degree angle, or maybe just a few degrees more. And what happens if you don't have the ankle range of motion, I'll show you. So if I don't have the ankle range of motion, all I can do is bend to here, that when I walk and my foot needs to, my body does it go over my foot like this, that requires 10 to 20 degrees of ankle range of motion. It's probably about 15 in the middle somewhere there. This ankle won't bend like this. And so what happens is the arch drops and your foot pronates. So your body is smart, and it wants to be able to accomplish this. But if you don't have that bend in this back ankle here, then your foot is going to make up for that. And it's going to give you motion here underneath the ankle joint. And that's what tends to create that painful plantar fascia pain, pain in the heel when you wake up in the morning, pain, you get up in the morning and you hobble out of bed, and then you could walk it off, but then it hurts later. So the solution is to stretch your calves, which I'll show you in a bit. I love to explain the biomechanics to people, because I think it's very important for us to understand why we're getting these things, why all of a sudden you have foot and ankle pain, why all of a sudden you can't walk anymore when you get out of bed without severe pain. Because a lot of these injuries, they just creep up out of nowhere in most people. Oftentimes people will be doing a workout program or they're walking more. And that's another reason why you can get these things. And the number one thing that you need to solve if you have plantar fasciitis is to stretch your calf. You need more ankle range of motion. Let's go to video number two to learn how to do that. So you have plantar fasciitis. You get out of bed each morning and you're hobbling because you have such intense pain. You're not able to do your walking program and you're just uncomfortable. I know I've had it a few times in my life with my high arches. What do you do? The first thing you need to do is calm the tissue down and start trying to get yourself out of pain. So what I tell everyone to do, I've been through this before, before I was a PT, is before you get out of bed in the morning, you need to move your foot up and down like this before you got a bed. Because what happens is we sleep and our feet are pointed. You're either laying on your back, on your side, face down and your foot is pointed. And that fascia is trying to heal all night long. And then you get up in the morning and you step on it and you re-tear it. You do those micro tears and that's why you're like, oh, as soon as you get out of bed. So if you move your ankle up and down like that, I say 20 times before you get out of bed in the morning, mostly up is the most important part. You're going to notice a dramatic difference in the pain when you get out of bed. At the end of your day to get out of pain throughout the day, this is a little extreme, but I use this and so do many of my patients. You can use a tennis ball and you massage very carefully, not the bones on the ball of your foot and not on your heel, but the area in between. It's soft. Don't massage the bones with these balls, the cross ball, tennis ball, golf ball, and you just go up and down longitudinally like that, massaging the plantar fascia. It will likely be painful, but you will find spots and after you're done massaging it out, you will have so much less pain. You can also, at the end of your day, step on an ice pack and massage and ice and calm down that tender area. You can do that several times throughout the day, but the most important reason you have plantar fasciitis is because you don't have enough ankle range of motion and you have to gain ankle range of motion. So there's two muscles that we need to focus and target when we're stretching our ankle to solve our plantar fascia problem and that is your gastrocnemius. It crosses the knee joint and the ankle joint. So you're going to put one foot in front of the other. You can hold on to something for some support. Your feet need to be in a straight line. You definitely don't want to be like this when it turned out because you're just going to strain the fascia and you don't even want to be a little bit turned out like that. You want to look down and make sure your back foot is in a straight line. You put the front foot forward and you bend the knee and stretch. I like dynamic stretching so I will bend and release to stretch the gastrocnemius. I'll show you from the side. Straight foot, bend and release. Bend and release. You can prop something under the first half of your foot here like let's say a yoga mat or a towel, bigger than this to get more of a stretch if you have more range of motion. The soleus is the other muscle. It does not cross the knee joint. It crosses the ankle joint and for that one you don't need as big of a stance but you bend the knee like this to stretch. That's how you stretch the soleus. We're stretching the back leg here. Right now you are solving the cause of your plantifasciitis but you still need to do with some strengthening of your foot and arch muscles. I like to do toe curls. Many people do toe curls where you literally just curl your toes. Some people will put a towel down. I do it whenever I stand at work and do it. I sit at the end of my day working on my laptop and do it. You can watch TV and curl your toes. You need to strengthen up all those little teeny muscles that support your foot to regain strength from the strain that has been happening because your calf didn't have enough range of motion and you need an exercise band for the last one. I'm going to show you on my left. You sit on the band, put your foot flat on it so it goes up over your toes. Straighten it out and you don't have to pull really hard here but you curl your toes, point your foot and release. Curl your toes, keep the curl, point your foot. Curl your toes, keep the curl. That will further strengthen the intrinsic muscles that have been weakened while your arch has been collapsing because your calves will be tight. So I think I made it clear everyone needs to stretch their calves. Now I mean everyone, not just people suffering from plantifasciitis, not just those suffering with Achilles tendonitis, everyone needs to stretch their calves. And it was a funny thing when I was living in New York City, I was seeing many patients coming in with back pain, knee pain, ankle pain, plantifasciitis, Achilles tendonitis, and they weren't starting a new exercise program. They were just doing the same exact thing that they've been doing for years, which is walking to work, walking up and down subway stairs, carrying their briefcase. And so I did a little test myself and every single person that came in, including people with neck and back pain, I would check their calves. And what I found is the majority of the people had about that L, that 90 degree angle, or just a little bit more, but they need 20 degrees of ankle range of motion. And so you saw in the first video, the biomechanics I was explaining, if you don't have enough ankle range of motion, your arch can collapse, your shin bone rolls in, the knee bone rolls in, and then your hip can collapse. And that is what can give you low back pain as well. So anyone watching the show, whether you have foot or ankle pain or not, stretch your calves, make sure that you have the normal and the adequate range of motion to get through your day without giving yourself an injury that you don't know is even occurring. Okay, so back to plantifasciitis. I have one more video to show you. If you have a very painful arch as a taping technique that I use on myself, my patients, it's very simple. And you can pretty much get tape anywhere right now. Let's go to the next video to show you how. If you have access to kinesiology tape, I like kinesio tape. That's kind of the original. And if not, you can use some rock tape. It's really good. You can get your roll and you can cut about a, see, maybe like a this inch length, six inches, whatever it is from you, the ball of your foot through your heel, you want to round the edges. And then this will help to support your arch if you have really bad plantifascia pain. This saved me when I was having my flares years ago. So you want to, you can start the tape the back to the front, or you can start the tape from the front to the back. I like to start it from the back to the front. You want to get this area of your heel, the inside, not just the whole thing, but a little bit more towards the inside. You want to lay the tape down when your foot is at rest this way. And then you're going to lay it down. I'm pulling on the white stuff as I pull my ankle up towards me. And then you're going to pull your toes forward at the last second. And so then you have the tape on the bottom of your foot like that. And that will just help to support your plantifascia while you're walking around during your day. You can also get over the kind of orthotics or arch supports to put in your shoes, which while you're trying to heal from your plantifasciitis, it will keep your arch up as you're gaining ankle range of motion. Okay. So that wraps up your plantifasciitis. Do those things they work. Don't forget ice at the end of your day. I see if you have pain, there's micro tears and inflammation happening. And make sure before you got a bed every morning that you move your ankle up is most important and down 20 times so that you don't re-tear that important fascia as you're healing. So now let's talk Achilles tendonitis. This is something that so many people suffer from and they have no idea why. Let's go to video number four to learn more. You have pain in the back of your ankle right on the Achilles tendon region. And that can be Achilles tendonitis or what we're now calling more Achilles tendinosis. And what happens is if it gets strained too much, this tendon right here, your Achilles tendon, can break down. And then you get terrible pain when you walk up and downstairs, mostly downstairs in the morning. When you step, when you squat down, you have this awful pain back here. If you're an athlete, when you land from running, it's very, very painful. Sometimes it can hurt on the inside of the tendon and very similar to plantifasciitis. One of the main reasons for Achilles tendonitis is that you don't have enough ankle range of motion here. So your calf comes down the gastrocnemius and the soleus and attaches into this tendon area and attaches at the back of your heel. And if you can see here, when I bend my knee, it tendons the Achilles. If you don't have enough ankle range of motion and you are arches dropping like this, that Achilles tendon is getting twisted like this as the heel rolls in and you're tibia, your calf muscle attaches to the bone here, stays here. It's getting twisted, twisted, twisted and it breaks down over time. There's constant strain. If you're an athlete, a runner, a jumper, going up and downstairs frequently, a home, whatever it is, if you've got a tight Achilles, tight gastroc, tight cilius, tight calf group, you can be at risk for Achilles tendonitis and you've got to stretch it out. Unlike plantifasciitis where we stretch the calf, Achilles tendonitis or tendonitis, it can be very painful to stretch. It could be painful at the Achilles when you stretch your calf. So there's other things that you can do. You need to stretch your calf and get an ankle range of motion but you just don't want to cause yourself more Achilles tendon strain or pain while you're doing it. So you can roll your calf muscle out right here on a foam roller. You can massage it yourself with the heels of your hand this way and I'm bending too. You can massage it this way. You can take a rolling pin, a baking rolling pin and massage it out. You want to try to loosen it out and you also want to do the stretching like you did the plantifascia. You just have to be careful because you don't want to increase Achilles tendon pain by stretching it out. So you want to go easy and use pain as your guide. So there's a little bit of information about how you got your Achilles tendonitis or tendonosis and how you can start to gently massage the tissue, stretch out your calf group so there's less strain on the Achilles but you're also going to need to strengthen. So let's go to video number five to learn what to do to do that. One reason that leads to Achilles tendonitis that's a little bit less easier to find for people or it might be a reason that you would never expect is if you have a weak hip and a weak gluteus medius muscle and so why this can give you Achilles tendonitis or plantifasciitis actually is this. So the weak gluteus medius when you stand on one leg would drop like that. It doesn't have the stability to keep your pelvis level while you're on one leg and so when you're dropped down like this you can see this angulation all of a sudden happen at my knee. So what happens I don't know if you can see it here is when it drops my arch collapse and I have this unstable foot. When I'm here I'm more stable on my ankle. When I drop my arch collapse my knee goes in I don't want to hurt myself but basically I'm putting my foot on the ground when this drops this femur bone rolls in the chin bone rolls in and your ankle collapses at the arch and then you set yourself for the same exact pain either in your plantifascius or in your Achilles as your calf muscle tries to decelerate that motion and it's getting twisted. So how you treat that cause of Achilles tendonitis your weak hip is causing extra motion to happen below which is leading your Achilles to get strained get tendonitis tendonitis is strengthen your gluteus medius you're going to put a band around your ankles or your feet you're going to lay on your back you're going to pull your toes up you're going to press down into the mat as if you're going to lift your glutes but you're more just squeezing your glutes and pressing down and you're going to slide the leg up to side will people make a mistake if they like to lift the leg and you can barely notice the difference you need to be pushing down you want to use your back butt here the gluteus medius you don't want to use the front muscles which would happen if you just slide you want to push down squeeze your glutes push down with your your calves your ankles and slide that muscle out to the side you can also a popular way is do you're on the side and you lift up this way again to be very specific you don't want to lift I'll show you from the side you don't want to lift up and forward which many people do you want to lift up and back up and back because that's what the gluteus medius does to stabilize your pelvis on your leg when you're walking so you get rid of your Achilles tendonitis and your plantar fasciitis so all of those videos explain to you great stretches great strength things great ways to alleviate your pain whether it's in your plantar fascia or in your Achilles but there's a couple other tips I want to give you that I share with my patients and one of those things is that when you're standing or walking I want you to look down at your feet and see if you tend to be walking or standing with one foot turned out to the side now there's many reasons that can happen people could have had a knee injury in the past an ankle sprain and bent on crutches you may have a bunion which is the toe kind of deviating inward that causes your foot to turn out the reason why you want to pay attention to that is if if you're symmetrically toeed out or you're symmetrically toeed in that's your structure but if one is a little bit more than the other that's and it's can be the side that you get the plantar fasciitis or Achilles tendonitis on or even knee pain you want to pay attention to that because that's abnormal movement and over time you're creating that arch collapse by having that one abnormally toeed out the simple fix is just to turn the foot straight like match it towards the other foot if you're really toeed out maybe turn it in just a little bit so you get that response you have less arch collapse especially if you're walking program or you're running or you're doing lots of stairs the other tip that I gave to someone really recently that they wanted me to share was she had terrible pain getting out of the bed in the morning and walking down her hall on her tile floor and so I said I used to be pigeon toeed I said you know what and I've had plantar fasciitis turn your toes in just a little it will stop the arch from collapsing so much you can walk down the hall and she said that was an incredible tip because she got out of the bed in the morning her foot hurt she turned her feet in and she said you know what it didn't hurt so she is now healing from her plantar fasciitis but she was having a hard time at first and some of those tips and strategies are ones that I came up with for myself when I had plantar fasciitis so I mentioned earlier a little bit more about how a tight calf could cause back pain and I want to show you a few things here because I've seen it happen before in New York City and I also want to say that many people have different levels of flexibility so you might be thinking oh my gosh my calves have been tight my whole entire life while me on the other hand I have been super flexible and large range of motion all my life which has led to some of my injuries that's okay we all have different anatomy the key is you just have to try to get to achieving normal range of motion so you cannot set yourself up for injury so in the next video video number six we're going to look at someone doing a squat who has limited ankle range of motion and you can see as he goes up and down his rear and his body will round and his butt kind of jumps back a little bit and his torso goes almost parallel to the floor as he gets down and he needs his arm for balance so let's look at that again so we can see just get a sense for what we're looking at here yeah and you'll see the little little struggle there in movement as he tries to get down his shin's trying to move over the foot but it can't there's not enough ankle range motion let's go to video number seven and we'll see there's a little bit of a block that we put under the heel it's a boogie board and look at the smoothness of the movement look at that up and down he's not struggling to keep his balance his torso is no longer going parallel now for for you know for you guys let's look back at number video number six so we can see the first one where you can see the limited ankle range of motion and how that's causing his butt to go back his back to round it's it's common to get a disc injury if you don't have ankle range of motion and you're lifting weights one of my colleagues was telling me the other day on how he had hurt his back and he was such limited ankle range of motion he had Achilles tendon tear and a surgical repair and he said gosh I attributed it to my ankle I was lifting weights I was doing squats and my ankle would not bend and now let's go back to video number seven we'll see the corrected position which is what it would look like if you had normal range of motion in your ankle and how free and how smooth that deep squat is free and smooth free and smooth so let's pop to image number eight so you can see a difference in two people's ankle range of motion so in the top that's the gentleman that we just saw that's him pulling his foot up as far as he can and you could see it pretty much hits the L or that 90 degree angle and if you look in the picture in the bottom that's my ankle and you could see it going well beyond to at least that 20 degree mark and while both of us have had problems with Achilles tendonitis and me plantar fasciitis as well mine from the hip instability and the weakness his from the lack of range of motion you do the same thing I was stretching my cap to make sure that I had proper adequate range of motion when it was tight he's stretching his cap I was strengthening my glute and doing all those curl point exercises and the toe curls to try to gain some stability for myself to stop the strain on my tissues and tendons which worked so we are all doing the same thing but we're doing it to achieve different reasons me for stability to stop my tendonitis and my plantar fasciitis him to get the range of motion so that his body has a normal range of motion so while he's doing his sports and activities he doesn't get the strain on his tendon so I hope that helps for everybody this has been really fun to deliver this on plantar fasciitis and Achilles tendonitis something I have suffered from as an athlete and little tips to fix it so I hope you learn something I hope that you have any questions you can send them to me you can connect with me on LinkedIn you just look up Christine lenders and as always life is better when you listen to your physical therapist aloha and thank you everyone thank you so much for watching think tech Hawaii if you like what we do please like us and click the subscribe button on youtube and the follow button on vimeo you can also follow us on facebook instagram twitter and linked in and donate to us at think tech hawaii.com mahalo