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Plantar fasciitis: trigger points, symptoms, and treatments
by Paco Amorós
Plantar fasciitis is one of the most common injuries among amateur runners and in some cases, if not given the proper treatment in time, it can become a terrible nightmare of several months of discomfort, pain, and inability to run.
Although annoying plantar fasciitis affects 10% of the population, it is more common in profiles such as the amateur runner, so let’s look at some tips for runners who want to recover from plantar fasciitis.
To answer the question of whether trigger points or “trigger points” can trigger plantar fasciitis, it is essential to define each of these concepts so that the possible causal relationship between the two can be understood.
The two sports specialties in which it occurs most are long-distance runners and basketball players. However, it can occur in people who do not exercise regularly, although in these cases it usually appears after the age of 45.
What is plantar fasciitis and trigger points?
In the anatomy of the foot, the “plantar fascia” or arched ligament is a band of connective tissue that joins the heel with the toes, that is, a thick ligament that extends when a step is taken. Consequently, if any tear or contraction occurs in the attached muscles, pain appears (plantar fasciitis).
Normally, it hurts in the heel area as injuries occur more frequently in this zone, but pain can appear in the middle and front part of the sole of the foot. The causes of this injury are diverse, including excessive physical activity, Achilles tendon retraction, arthritis and diabetes, and even wearing faulty footwear. But then, what is the relationship with trigger points?
A trigger point is a very specific area or a group of fibers that contracts within the muscle tissue, forming a kind of nodule that causes pain when active. People who suffer from them often refer to them as “balls”, “contractures”, or “knots” because they can feel, when applying pressure to them, a kind of swelling.
A characteristic of these nodules is that they can be highly irritable and be a source of pain in the area where they are located or radiate pain to other areas of the body. They are caused by excessive muscle contraction, stress, or inadequate calcium metabolism.
Well, by linking both concepts you can sense what happens in this case. One or more trigger points located in the calf muscles (external and internal) can project, as happens on numerous occasions, pain towards the heel. Trigger points do not follow neurological or visceral patterns, so sometimes it is difficult to locate them and the amount of pain depends on their degree of irritability.
Plantar fasciitis, a frequent injury in athletes
Plantar fasciitis occurs due to the overloading of the fascial tendon tissue that supports the foot and is located on the sole. Athletes who perform continuous effort and very repetitive movements with their feet, such as track athletes, soccer players, or basketball players, tend to be among those most affected by this ailment.
How does plantar fasciitis occur?
The function of the plantar fascia is to provide stability and shock absorption capacity to the longitudinal arch of the foot. The inflammation of the membrane or aponeurosis that covers the muscles of the sole of the foot and its insertion area in the heel, caused by traction in each impact and in the propulsion movements of the foot, is what is called in sports medicine, plantar fasciitis.
The high-performance activity to which professional athletes subject their heels, especially when running on hard terrain or surfaces, causes continuous percussion on the soles of the feet, producing micro-traumas, which in turn are responsible for a possible inflammation of the heel and its consequent generation of pain.
In some cases, chronic heel pain can also be caused by what is called a calcaneal spur (a peak at the bottom of the heel seen on an X-ray), which also causes inflammation around the fascia fibers, although it does not have to be the cause of plantar fasciitis. Between 15% and 25% of the population has a calcaneal spur but experiences no pain and, conversely, many runners with plantar fasciitis do not have one.
The main causes of this injury are:
- Overload: It is usually the most common and is caused by excessive use of the joint or the repetition of a sports technique developed incorrectly.
- Change of footwear: It is very common for pain to appear in the plantar fascia when renewing running shoes.
- Bone problem: Some type of bone malformation can generate plantar fasciitis.
Main symptoms of plantar fasciitis
When suffering from plantar fasciitis, the main symptoms are as follows:
- Pain: It is what the patient suffers most and the first thing they notice when performing any sports activity.
- Hypersensitivity and swelling
- Heat
- Redness
- Tension in the sole of the foot
Prevention
Preventing plantar fasciitis is relatively simple: warming up and stretching before physical exercise is fundamental to avoid it. Before each workout, a gentle 5 to 10-minute run is recommended. Afterwards, it is necessary to perform, in addition to general stretches, specific ones for the sole of the foot to decrease the likelihood of injuries to the foot fascia and muscle-tendon structures.
The choice of the right running shoe is essential. The running shoe must be comfortable, with a size appropriate for the foot since feet may not be symmetrical. The athlete should try on each new pair of running shoes even if they are the same model they usually use.
How to treat plantar fasciitis?
The treatment of trigger points is based on physical therapy with pressure massages on these nodes. The most commonly used techniques that produce significant improvements are decontracting mesotherapy, cryotherapy, the dry needling technique, performing stretches prescribed by the physical therapist, and post-isometric relaxation.
In summary, when there is pain in the sole of the foot and there has been no injury or any of the usual causes have been ruled out, it is necessary to direct the examination towards detecting trigger points as a possible cause of plantar fasciitis.
Once the diagnosis is made, usually through physical examination and the description of symptoms reported by the patient, the sports doctor will decide on the action protocol to be carried out. Only exceptionally is surgery used to treat this type of injury.
While there is no evidence of the effectiveness of a specific treatment for plantar fasciitis, there are a series of recommendations that in many cases can lead to its cure. Among them is the correction of training errors.
To heal quickly and without relapses, the injury must be identified as soon as possible and you must start avoiding the painful movement that causes it, since once it is established, it can take 8 to 18 months for a definitive cure.
Treatments for plantar fasciitis
- In the acute phase of pain, ice will be used, and massages will be applied over the area for 10 or 20 seconds, 3 or 4 times a day. This prevents inflammation. The repeated use of ice or cryotherapy is the most effective treatment since the cold limits pain, swelling, bruising, and inflammation.
- Continuous ultrasound (5-10 W/cm) for about 5 minutes a day will be used in the post-acute phase of the injury, after 48 hours. The effects of ultrasound (pain reduction, increased blood flow, increased metabolism, and reduction of muscle spasm) help in treating the injury and give good results in athletes.
- A deep massage, in small circular movements over the affected region, will help reabsorb the edema and reduce muscle spasm.
- The combination of ultrasound with electrical stimulation can also be effective. The ultrasound acts on deep tissues and muscle stimulation increases the flexibility of the sole of the foot.
- Extracorporeal shock waves can help runners and athletes with plantar pain of more than a year’s duration, with chronic pain in the heel area. Some doctors recommend it, but its effectiveness is still under study.
- Taping (bandaging with adhesive tape strips) can help soothe the pain. A bandage of this type will limit tension on the plantar fascia. It is also useful in case of an aponeurosis rupture.
- When experiencing acute pain, insoles for shock absorption, offloading insoles, or custom insoles with previous biomechanical studies to correct foot varus-valgus can be used.
Tips for dealing with plantar fasciitis
If you suffer from plantar fasciitis, the first thing is to rest. It’s never easy, especially if your job requires a lot of walking, but the ideal is to reduce the number of running days, or even replace intervals with swimming or cycling. It is also recommended to put a small bottle of frozen water under the sole of the foot and roll it slowly for about 8 to 10 minutes two or three times a day.
We should also pay attention to footwear (and not just what we use for sports, but also what we use in our daily lives), an aspect we don’t always give the importance it deserves and that can be behind sports injuries like plantar fasciitis. Whether for running or for everyday use, use shoes with good cushioning that are comfortable and support the arch of the foot.
Watch out for flip-flops
Be careful with flat or worn-out shoes and running shoes; likewise, be careful with the use of flip-flops because it is a type of footwear that can cause many problems if not used correctly.
In this article by Podoactiva they explain very clearly the risks of improper use of flip-flops.
Don’t forget stretching as well, both for the foot muscles and the heel. In fact, you can do exercises to strengthen those muscles, for example picking up marbles with your foot and putting them in a cup or a towel from the floor with your foot. Stretches with an elastic band and calf stretches are also interesting.
Finally, it is recommended to see a specialist so they can prescribe pain relievers like ibuprofen or even the use of a splint while we sleep. Physical therapy work is another treatment that will help you recover from plantar fasciitis; your physio will give you good guidelines to follow to cure it and prevent future problems.
If medical treatment fails, surgery can be performed. Experts only recommend surgery if the pain persists after three months of treatment. The foot is one of the key anatomical structures for an athlete. Any discomfort caused by the effort involved in high competition that affects this area conditions mechanics and can cause other injuries in the knees, hips, etc.
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