Plantar fasciitis is a common term used among physiotherapists, but what does this term really mean? It is when one experiences pain on the heel and the bottom of their foot (footbed). It is common for runners to get planter fasciitis after a period of excessive running, if they are standing a lot during the day or have a few extra kilos to burn off.
What is Plantar Fasciitis?
When talking about planter fasciitis, you will most often hear very general terms such as " decrease in quality of the tissue" but what causes this decrease in quality is still largely unknown. It was previously thought that plantor facisiitis was connected to inflammation of the tissue but as more information becomes available, researches believe that the cause is more likely a result of micro-ruptures in the tissue in the foot.
What is known is that Plantar fasciitis is a decrease in the quality of the tissue in the foot (fascia plantaris). The fascia plantaris absorbes the incoming forces of landing while running.
Symptoms
If you have pain in your foot, and are wondering if you could have Planter Fasciitis, a few things you could look out for are:
pain during the first steps after getting out of bed.
During the night the foot flexes.
After sleeping the footbed is rigid and therefore painful during the first steps, because it stretches the footbed.
Just remember that this list is not exhaustive and it is always good to consult a physiotherapist. When you go to your physio with your concerns, you can expect that they will consult with you about the following:
When you get out of bed, are the first steps painful?
Does the pain fade away after walking for a few minutes?
Does the pain increase after intense training?
What sort of pain do you feel in the heal? Poking pain?
When you flex your foot upwards, is it painful?
If the answer to these questions are yes, it is likely that your physio will conclude that you have planter faciitis. They may sent you for an Ultrasound or MRI, but in many cases it is not necessary.
Your physio may also find another diagnosis which often presents itself in a similar way. These can include but are not limited to: ankylosis spondylitis, Reiters syndrome or nerve pain.
Treatment
There are different ways that you can search for treatments for Planter Faciitis. Some less invasive ways of addressing your pain is through stretching and strength exercises, ice massage and changes to your current exercise routines. There are also other treatments available such as anti-inflamatory drugs, shockwave therapy, protein injections or even surgery.
Below you can find a more comprehensive list of different treatments accompanied by further explanation.
Education
Good understanding of plantar fasciitis is crucial in the treatment of plantar fasciitis. Why?
Stretch exercises
The fascia plantaris stretch: pull with your hands your toes up and pull with the other hand the heel up resulting in a stretch on the footbed.
Achilles tendon stretch via m. gastrocnemius: place one foot in front of you and bend through this knee while keeping your other leg straight.
Achilles tendon stretch via m. soleus: place one foot in front of you and bend through this knee and make a slight bend in your other knee.
Place your toes on a elevation of 1 inch. Push down your foot so you feel a stretch in your toe tendons
All the stretch exercises should be maintained for at least 30 seconds and repeat the stretch exercises as often as possible. Most often I keep stretch on the muscle for 40 seconds and repeat this stretch two times.
Strength exercises
Put a dynaband over the ball over your foot while seated. Push your foot away from you powerfully (plantar flexion) and slowly let your foot come back to the beginning position (dorsal flexion).
Ice massage
Role a frozen can under the footbed for 5 to 10 minutes with average pressure. Especially in the evening an ice massage could help against the symptomes of plantar fasciitis.
Training modification
Running on hard surfaces like paved road and tread mill should be avoided, because hard surfaces is more demanding for the footbed (fascia plantaris).
To keep your stamina up, you could consider to practice other sports which are less demanding on the footbed. For example swimming, rowing and cycling could be great alternatives for running to overcome the plantar fasciitis. These sports are just like running cyclic and cardiovascular sports. You could practice these alternative sports until you recovered from plantar fasciitis.Om de conditie op peil te houden, zou u minder belastende activiteiten als zwemmen, roeien en fietsen kunnen overwegen.
Eccentric strengthening of the calve muscles by doing calve raises
Shockwave
Uit onderzoek is gebleken dat shockwave betere resultaten haalden binnen een groep dan een placebogroep. Bovendien is shockwave vrijwel risicoloos. Daarom is shockwave zeker de moeite waard om uit te proberen.
Nachtspalk
Een spalk in de nacht wordt gedragen om het samentrekken van de voetzool te voorkomen. Dan is er sprake van minder spanning op fascia plantaris bij de eerste stappen na het uit bed komen. Het voordeel van een nachtspalk is dat het de ergste pijn, namelijk de pijn bij de eerste passen na het opstaan, wegneemt. Uit onderzoek bleek dat bij de meeste deelnemers de pijn afnam na vier weken een nachtspalk gebruiken. Na 12 weken was bij de meeste deelnemers de pijn zelfs compleet verdwenen. Het nadeel van een nachtspalk is dat het totale ontspanning van de voetzool onmogelijk maakt. Ook is er geen bewijs gevonden dat het de oorzaak van de fasciitis plantaris wegneemt op de lange termijn.
Orthese
Het gebruik van inlegzooltjes raad ik aan. Er is bewijs gevonden dat inlegzooltjes een positief effect hebben op het wegnemen van fasciitis plantaris.
Overigens maakt het niet uit of de zooltjes op maat gemaakt zijn of dat het massaproductie zooltjes zijn. Er is geen verschil gevonden in effect.
Ontstekingsremmers
NSAID's raad ik af, omdat het niet zeker is dat het om een ontsteking gaat. Bovendien leiden NSAID's ertoe dat fasciitis plantaris in een later stadium moelijker te behandelen is. Het gaat bij NSAID's dus om een tijdelijke oplossing die op de langere termijn schadelijk is.
Wanneer kan ik na fasciitis plantaris weer hardlopen?
Een ongeschreven regel is dat mensen met fasciitis plantaris na 4-6 weken zonder symptomen weer kunnen gaan hardlopen.
