Hey Team, 

This week we are looking at foot pain experienced with the first few steps in the morning.  Image stepping down on the ground and taking your first step with an immediate OUCH! That hurt and you hop back to bed quickly!  I get asked often why this occurs and how to prevent from continuing to cause pain.   

Why does this happen at all?

Well… it comes down to the Windlass Mechanism.  What is that?  (Nerd alert be ready)

• The term ‘windlass mechanism’ relates to the dynamic bow-stringing effect created by a number of important structures of the plantar aspect (underside) of the foot. This dynamic action involves the plantar fascia, foot bones, great toe and the heel. 

• If you lift up on any of the toes in a weightbearing foot, especially the great toe, you pull on the plantar fascia and the arch is lifted up, activating the windlass mechanism. This works on all toes but is much more powerful on the great toe.

 But why does this matter?

The plantar fascia is a thick ligament on the undersurface of the foot and the Achilles tendon is a thick tendon on the opposite side of the heel. The Achilles tendon is attached to the calf muscles on the back of the lower leg.  Both of these structures attach to the heel… but on opposing sides.  The plantar fascia and Achilles can work dynamically together to allow you the ability to perform all weight bearing activity, but when compromised… they can be worst enemies.  

So why am I getting heel pain?

The Achilles tendon and the plantar fascia work dynamically to propel you forward while walking thru the Windlass Mechanism.  This mechanism locks your foot as the great toe is extended and gives you a ridged lever to push from.  It allows you to walk fast, run or jump.  But when the Achilles or plantar fascia is restricted, and repetitive activity continues… pain/dysfunction can begin.  This is a result of repetitive microtrauma occurring at the insertion of the plantar fascia or the Achilles tendon… overall creating irritation to these sites.  So the pain felt is usually at the insertion of the plantar fascia into the heel bone.  

Why does it hurt so much in the morning?  

Our plantar fascia is relaxed when we sleep due to the fact we are not in a weight bearing position.  The plantar fascia continues to relax and is less pliable in the morning.  The first step elongates the planta fascia quickly… and creates immediate pain.  Nobody likes to wake up abruptly…. Neither does the plantar fascia!

(CLICK HERE )Here are a few ways to help in the morning before getting out of bed.

How can I prevent this in the future or make my heel pain go away?

The calf muscles connect to the heel through the Achilles tendon.  The calf itself can become restricted, shortened or develop tightness from disuse, overactivity, strain or other.  Once the calf muscles become shortened… the ankle is restricted.  With a restricted ankle the pain will generate in the Achilles or the plantar fascia.  So in short…address calf mobility and you will help your heel pain.

Check out this latest video to learn how to improve ankle mobility.

CLICK HERE TO WATCH: ways to improve ankle mobility.

Ok Team… that’s all for today.  Reach out to me directly if you have questions about ankle, plantar fasciitis, Achilles tendonitis, our youtube link or other physical therapy questions.  

-Keep Moving,

 Rob 

The author, Rob Sumner, is a Doctor of Physical Therapy and owner of Sumner Specialized Physical Therapy. He's happy to answer any questions about this article, wellness, fitness, or physical therapy overall by phone at (509) 684-5621 or by email at Rob@SumnerPT.com

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