First few steps in the morning uncomfortable?

By Kate Zanoni, LPTA
Have you ever experienced a sharp pain in the bottom of your foot when you take your first few steps in the morning? Does your ankle feel unstable or painful when you’re walking or running? Do you have difficulty balancing on one foot without holding onto something for support?
These are all signs of common foot and ankle conditions that we often treat in physical therapy. Although there are many contributing factors leading to the aforementioned symptoms, here is a breakdown of the most frequent causes of foot and ankle pain as well as resulting ankle instability.
Pain in the bottom of the heel or the arch of your foot is due to tightening of the plantar fascia, connective tissue that runs from your calcaneus (heel bone) and spans the length of your foot, attaching to your toes. Calf tightness can contribute to plantar fascia irritation as well since both structures insert into the calcaneus. Morning pain is caused by the position of the foot while sleeping. Our feet naturally fall into a plantarflexed position at rest, meaning our feet are slightly pointed rather than resting in a neutral ankle position, tightening the tissues on the bottom of the foot. Over time, this leads to irritation and inflammation in the plantar fascia, which is known as plantar fasciitis.
Physical therapy is effective for plantar fasciitis with the use of manual therapy to break up the adhesions and fascial tightness in the plantar fascia as well as strengthening of the small intrinsic foot muscles to reduce arch collapse.
When you have pain on the outer portion of your ankle, it is likely due to peroneal tendonitis, which is inflammation of the peroneal muscles that run the length of the lateral side of your lower leg. Poor foot and ankle mechanics lead to overuse of the peroneals, causing inflammation and pain with weight bearing activities.
Physical therapy for peroneal tendonitis includes manual therapy to reduce muscle tension, joint hypomobility and tendon irritation, exercise instruction in foot and ankle mechanics to reduce the overloading of the peroneals and strengthening of proprioceptors that aid in balance and ankle stabilization.
Pain experienced on the inside of the ankle is often caused by posterior tibilais tendonitis, which is inflammation caused by overpronation and overuse of the muscles on the medial side of your lower leg. Poor balance, stability and ankle mechanics lead to overpronation, arch collapse and, therefore, increased inflammation and pain. The use of properly fitting arch support and supportive shoes is essential, but is often not enough to combat these symptoms.
Physical therapy for posterior tibialis tendonitis includes manual therapy to address muscular and joint restrictions to restore normal range of motion and mobility of the ankle and supporting muscles, strengthening of the muscles and mechanoreceptors in the foot and ankle to improve dynamic stability and reduce overpronation, and biomechanical instruction in proper foot and ankle alignment to avoid overuse of one muscle group.
If you experience foot or ankle pain, have a history of ankle sprains or instability or have poor ankle control, call Loudoun Sports Therapy Center today at 703-450-4300 to schedule an appointment with a physical therapist. During your initial evaluation, our movement experts will analyze your pain and strength deficits to create an individualized plan of care to reduce your pain, increase your strength, stability and balance to help you return to the activities you love most.