1. Loss of ankle movement called dorsiflexion- the movement where you bring your toes towards your you

2. Foot arch deformities- either flat feet or very high arches

3. Excessive foot pronation when walking

4. Impact/weight-bearing activities such as prolonged standing, running, etc

5. Improper shoe fit

6. Being overweight

7. Diabetes Mellitus (and/or other metabolic condition)

8. Leg length discrepancy

9. Tightness and/or weakness of the calf muscles (Gastrocnemius and Soleus), Achilles tendon, and intrinsic muscle of the feet.

9. Work-related weight-bearing

1. Eliminate the high heels at work and walking barefoot at home. Both of these would have aggravated the soft tissue and contributed to the pain.

2. Advised to wear more moderate heeled shoes at work and wear sneakers with a soft, cushioned sole at home.

3. We advised her to keep up her cardio with rowing or swimming- both non-weight-bearing activities that would allow the heel to rest but still keep Andraya active.

4. We encouraged Andraya to do these activities 2-4 per week to keep her on track with her weight loss goal.

5. Taping- we strapped her foot to relieve pressure and pain

6. Soft tissue massage to the soft tissue in the midfoot

7. We performed mobilizations to the foot- these are movements of the joints in the foot

8. We advised Andraya to use off-the-shelf silicone heel pads to wear in her work shoes. These are used to alleviate the direct pressure onto the heel when walking.

9. Dry needling of the calf muscles to release tightness

10. Stretches and exercises were also given for Andraya to do at home.

1. Plantar Fascia Massage: Massage the area by rolling a small ball (Lacross ball or tennis ball) or frozen water bottle forward and backward under your foot. Start at the heel and move towards the ball of your foot just before you reach the base of your big toe. Do 10 repetitions of the movement and 2 sets, twice per day.

2. Heel raises: Find a step in your home and stand on it with your heels hanging off the end. Now raise your heels until you are balancing on the ball of your foot. Repeat this movement 10 times and do 2 sets every day.

3. Floor sitting ankle inversion: To do this exercise you’ll need a resistance band. Sit on the floor with your hips level and your legs straight in front of you. Put one leg over the other with a resistance band tied around the upper foot and looped around the bottom of your lower foot. Move the upper foot away from the lower foot by rotating your ankle inward (as per the image above). Repeat this exercise 10 times on each foot and do two sets, twice per day.

4.Seated toe towel scrunches: Sit on a chair with a towel under your barefoot. Spread your toes wide and grab the town with them drawing the towel towards you. Do this 10 times per foot and do 2 sets twice per day.

5. Seated Plantar Fascia stretch: Sit on a chair and put your outer heel on the knee of your resting leg. With one hand holding your ankle and the other holding your toes, gently pull your toes backward until you feel a stretch in the bottom of your foot. Hold the stretch 20-30 seconds on each foot and then release. Repeat the stretch 3 times daily.

6. Calf stretch against a wall: Stand upright facing a wall and place your palms flat against it. Bend one leg and step back with the other. Keep your back leg straight and your front leg bent. You should feel a stretch in the calf of your back leg. Hold the stretch 20-30 seconds on each side and then release. Repeat the stretch 3 times daily.