The plantar fascia is a structure commonly injured in runners and cyclists, especially those who practice endurance sports such as trail running or road and mountain cycling. Its main function is cushioning and supporting the plantar arch. Athletes who use mountain bikes or road bikes often put a lot of strain on this area of the foot due to long training sessions and the sustained position on the pedals.
The pain usually begins on the medial side of the heel and extends toward the central part of the plantar fascia, progressively increasing at the end of the day, especially after a demanding outing or an intense session. In advanced stages, it can cause functional impairment so severe that it prevents the athlete from continuing with their usual training, whether in carrera or on the bike.
What is plantar fasciitis or fasciosis
The plantar fascia is a band of dense, fibrous connective tissue that originates on the posterior aspect of the calcaneal tuberosity and extends to the toes. This plantar aponeurosis is made up of longitudinally organized fibers, divided into three portions: the medial, which is the thickest (approximately 4mm), the lateral, and the central. These fascia fibers continue with the fibers of the Achilles tendon.
What is its function
The biomechanical functions of the foot fascia are:
- To support and maintain the plantar arch
- It acts as a good cushioning mechanism in the final support phase during the gait cycle, under the metatarsal heads
- It makes the propulsion forces during walking more effective
- Distributes the weight exerted on the forefoot among all the metatarsal heads
Etiopathogenesis
Plantar fasciosis is most frequently located in the proximal third, where the plantar fascia inserts. The etiology is multifactorial, with the following intrinsic factors standing out among athletes:
- Valgus hindfoot
- Hamstring tightness
- Shortening of the Achilles-triceps surae complex (gastrocnemius and soleus) plantar
And extrinsic factors:
- Increase in training kilometers in short periods of time
- Poor choice of footwear
Diagnosis of plantar fasciitis
It is very important to perform a differential diagnosis with other pathologies that cause similar pain in athletes, such as nerve entrapments, plantar fat pad atrophy, or calcaneal stress fractures. To make the diagnosis, a thorough medical history, physical examination, and ultrasound study will provide us with the necessary data to apply the most appropriate treatment for the patient, so that they can return to sports activity as soon as possible and fully recovered.
Prevention
Preventive treatment is always the first choice, so you should follow the guidelines indicated below to avoid suffering from plantar fasciosis:
- Biomechanical gait analysis
- Ultrasound study at the first symptoms of plantar pathology
- Stretching of all the posterior leg muscles after each training session
Treatment of plantar fasciitis
The treatment of choice depends on the phase in which the fascia is, which we will see with the ultrasound study. Initial phase: conservative treatment with physiotherapy (ultrasound, low-intensity laser, functional taping, etc.), NSAIDs (non-steroidal anti-inflammatory drugs), custom plantar orthoses, and anti-equinus night splint is recommended. Chronic phase: treatment should be invasive, with percutaneous intratissue electrolysis, corticosteroid infiltration, and high molecular weight hyaluronic acid infiltration. Return to sport: whenever the athlete goes through an injury and subsequent treatment, they must undergo a readaptation to sports practice with the help of their physical readapter, so that recovery is a total success.
