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 the aponeurosis plantaris). This tendon plate begins at the heel and runs to the toes through the underside of the foot. Excessive strain or lack of recovery time can lead to an imbalance in load/strain capacity of the tendon plate. Because of this, complaints can occur that mainly manifest as pain and are mainly present when loaded. What we often see in practice is that people have started to do more in the short term than before (the intensity has increased). This can be sport specific, but can also be work related (for example, a standing job).
Heel spur symptoms 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 mileage 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 role 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 (resulting in poor load bearing) or, on the contrary, overuse (excessive use).
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. Therefore, it is recommended to walk with shoes that provide adequate support and cushioning. Think sneakers or athletic shoes. Walking in heels or slippers can be experienced as unpleasant, so this is not recommended for this type of complaint. Pressure or palpation (touch) of the heel can cause recognizable pain.
Levels of a 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 is present throughout the sporting activity.
- Stage 4; pain is present even more than 24 hours after exercise as well as 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 condition is not the problem then, but rather the load capacity of the tissue (muscles, tendons, connective tissue) that must 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 taken into account enough when building up the above activities.
Treatment methods for heel spur
A heel spur complaint is annoying and can be persistent. There are several treatment interventions for heel spur symptoms.
- Dry-needling. In some cases, the choice is made to apply dry-needling to this injury. Dry-needling is aimed at treating trigger points (painful points in muscles). Dry-needling can be of added value to (temporarily) reduce the experienced pain. We know from research that it does not change the recovery time or the 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. Stress is all-embracing and often you are stressing more than you realize. Load includes; exercise at home, work, sports, stress/strain etc.). By first reducing the load and then using an appropriate exercise program to gradually build up the load again, we ensure that the capacity of the tendon will increase again.
- Practicing at home. Exercises can be performed at our training facility, but can also be performed 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.
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