Plantar fasciitis in athletes

The plantar fasciitis zone is a structure formed by collagenous tissue that is located on the sole of the foot and expands from the heel bone to the anterior region. Its main function is to cushion and support the foot when we walk, run or jump.

That is why it is one of the most common injuries in runners. But not only the impact influences the alteration and development of the disease.

Weight, height, age or having one leg shorter than the other also have an impact, although the most important factor is the type of footprint. Incorrect stepping increases repetitive microtrauma on the plantar fascia and causes inflammation in the area.

In recent years, the concept of fasciosis (degeneration) and not fasciitis (inflammation) has been used because regenerative therapies are applied as treatment.

Symptoms and manifestations of fasciitis

In severe cases, plantar fasciitis may cause lameness when getting out of bed or after sitting for a while, although it is relieved after a few steps.

As the disease progresses, the pain may move to the forefoot, following the internal plantar arch. If sport is practiced it is possible to alleviate momentarily the discomfort, but when finishing the foot cools down and the pain reappears in a more intense form, being able to be maintained for two or three days.

Diagnostic tests

Through the X-rays it is possible to appreciate a calcaneal spur. The spur is not the disease but the end result of a fascia and a short plantar musculature overloaded for a long period of time. Feet with a lot of bridge (pes cavus) can increase the stresses on the plantar fascia.

It is advisable to complete the study of the plantar fascia with ultrasound or magnetic resonance imaging. These tests are used in cases of sudden pain or inflammation to rule out a possible acute rupture of the fascia.

It is also advisable to perform these tests to rule out other types of injuries such as osteoarthritis in the joints, calcaneal fat atrophy or tarsal tunnel syndrome.

Treatment

The treatment will be directed to correct the origin of the problem and to regenerate the damaged tissues. In the case of athletes, especially runners, it is essential to determine the type of footprint to rule out that the problem is that. To do this, a biomechanical study of the footprint is performed and a plantar support is made.

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Once the footprint is corrected, the treatment progresses to the regeneration of the collagen of the fascia. Several techniques are used and their application will depend on the evolution of the patient and the severity of the injury.

The four most commonly used methods are:

  • Percutaneous intratissue electrolysis (PIE).
  • Plasma rich in growth factors (PRFC).
  • Prolotherapy.
  • Shock waves.

These techniques destroy the damaged tissue and then regenerate it to accelerate the healing of the plantar fasciitis tissue.

Treatment success

Precision is the most important factor and can predict the success of the treatment. For this purpose, high-resolution ultrasound examinations are performed to infiltrate the growth factors in the right place. In the case of athletes, this tool becomes even more relevant because the posterior tibial nerve is anesthetized without damaging the artery.

During the treatment it is recommended to follow a series of exercises to strengthen the posterior area of the leg, hamstring, soleus, calf and Achilles tendon muscles. As a last option, surgical intervention is considered. It consists of loosening the fascia in the area of its insertion in the heel bone, the damaged region.

It can be done in two ways:

  • Percutaneous. Without using a standard incision and being able to resect the heel spur.
  • Endoscopic. Introducing a small optic to perform the fasciotomy.

The less invasive surgery accompanied by an ultrasound allows to be more precise and selective, without damaging associated structures, and favoring a faster recovery of the athlete. For cases in which all of the above has not been successful, an open exposure of the area and a partial or total fasciotomy is performed, in addition to detaching the nerve branches that may be affected by the chronic process.

Recovery should be progressive and regular visits to the podiatrist should be made in case the insoles need to be readapted to the new situation. As for sports activity, this process may be slower and take weeks or even months of progressive strength, endurance and proprioception training.