EN 
NL Heel spur complaints plantar fasciitis
Heel spur symptoms are common in runners and walkers, among others, mainly in the 40-60 age group. A heel spur originates at the underside of the foot (the tendon plate; plantar fascia or aponeurosis plantaris). This tendon plate starts at the heel and runs to the toes via the underside of the foot. Excessive strain or, on the contrary, too little recovery time can lead to an imbalance in load/strain capacity of the tendon plate. As a result, complaints can occur that mainly manifest as pain and are mainly present when loaded. What we often see back in practice is that people have started doing more in the short term than before (the intensity has increased). This can be sport-specific, but can also be work-related (in a standing job, for example).
Cause
Heel spur complaints can occur after prolonged periods of (excessive) strain combined with insufficient recovery. A standing profession (e.g. pharmacy assistant, personal trainer, nurse, etc.), sports with high kilometre intensity (running/walking) can eventually lead to irritation of the foot. This is not to say that this is always the case, just that it can play a part in the development of a heel spur injury. Other causes that may play a role in the onset of heel spur symptoms include; obesity, abnormal foot position (hollow/flat foot), shortened Achilles tendon or calf muscle, inactivity (causing poor load bearing) or, on the contrary, when overuse (using it excessively).
Complaints and symptoms
Heel spur symptoms can get worse over time if you do nothing about them. Pain symptoms can be experienced while standing or walking (or both) for long periods of time. In some cases, people also experience stiffness. Stiffness is most present in the morning or after an extended period of rest. This stiffness also subsides again once you start moving. With heel spur symptoms, walking on a hard floor uncomfortable, this is due to the direct pressure on the painful tissue. It is therefore recommended to walk with shoes that offer sufficient support and cushioning. Think trainers or sports shoes. Walking in heels or slippers can actually be experienced as unpleasant, so this is not recommended for this type of complaint. Pressure or palpation (touch) of the heel can cause recognisable pain.
Treatment methods for heel spur
A heel spur complaint is annoying and can be persistent. There are several treatment interventions for heel spur complaints.
- Dry-needling. In some cases, dry-needling is chosen for this injury. Dry-needling is aimed at treating trigger points (painful points in muscles). Dry-needling can add value to (temporarily) reduce the pain experienced. We know from research that it does not change anything in recovery time or quality of recovery. This intervention can be used, but always in combination with exercise therapy.
- Exercise therapy. Training to make the tendon plate loadable again. In this case, we look at load capacity (how much can your body handle) and load given. Loading is all-embracing and often you are soon loading more than you realise. Load includes: exercise at home, work, sports, stress/strain etc.). By first reducing the load and then gradually increasing it again with an appropriate exercise programme, we ensure that the strain on the tendon increases again.
- Practising at home. Exercises can be performed at our training hall, but can also be done at your home. Think especially of bodyweight exercises where you will need few materials. Depending on your own situation and wishes, we can design your treatment.
Levels of heel spur (tendonitis in general)
- Stage 1; there is pain and/or stiffness after exercise
- Stage 2; there is pain during warm-up. These disappear when you warm up properly.
- Stage 3; pain symptoms are present throughout sports activity.
- Stage 4; pain is present even more than 24 hours after exercise and during daily activities.
Heel spur complaints among runners and walkers
Runners and (long-distance) walkers are a group in which heel spur complaints are a regular occurrence. What we often hear and see in practice is that athletes build up in intensity too quickly. Often, fitness is then not the problem, but rather the load capacity of the tissue (muscles, tendons, connective tissue) that should be able to deliver just as well. Building up too quickly in intensity (distance/time), frequency or too little recovery time in between can then lead to complaints. Tendon tissue can withstand tensile forces very well, but it does have the characteristic that it needs time to adapt to changing conditions. This is what is often not sufficiently taken into account when building up the above-mentioned activities.
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