Plantar fasciitis hardly needs an introduction. Its prevalence in the sporting community, with recreational outdoor enthusiasts and innocent bystanders alike is both well documented and proven daily in most clinics today.
With its symptomatology of inflammation and pain of the fascia and surrounding perifascial structures, this condition is one which patients demand answers to quickly.
Most will agree that plantar fasciitis is often caused by repetitive stress in the form of micro-trauma to the plantar fascia. The most common site of pain is the medial tubercle of the calcaneus and secondarily deep within the medial arch in the belly of the plantar fascia.
However, is this micro-trauma the cause of the ailment or simply another symptom of a more significant problem?
If we take a moment to review the biomechanical norms of foot posture and the innate response of the foot to faulty posture, then the potential true cause of plantar fasciitis comes to light.
The 33 joints of the foot all have a specialised purpose and allow certain ranges of motion in an integrated manner. Those joints can only move smoothly if each individual bone is held in its correct biomechanical location.
Faulty structure will always lead to faulty function and disease. Hyperpronation of the foot requires hypermobility of foot joints leading to collapse, whilst oversupination highlights a lack of mobility and poor ability to absorb ground reaction forces.
Neither of these scenarios is healthy and the foot will eventually respond to the fault.
The Windlass Mechanism describes the plantar fascia’s reaction to a flattened medial arch. When the truss arch structure (formed by the calcaneus, mid-tarsal joint and metatarsals) collapses the plantar fascia is described as the tie-rod that attempts to ‘right’ the arch.
The term ‘windlass’ refers to a tightening of rope-like structure and describes the attempt of the plantar fascia to prevent or correct arch collapse by tightening and pulling the origin and insertion points closer together.
In reality, the tensile strength of the plantar fascia is not enough to repel the ground reaction forces coming upward and the body weight force coming downward forcing the arch collapse. But the plantar fascia will not accept defeat and continues to contract and pull on the attachment points.
Time allows for chronic spasm of the plantar fascia, inflammation at the origin and insertion points, and repetitive stress at the medial tubercle of the calcaneus. The calcaneus then succumbs to Wolff’s Law and begins laying bone and forming a heel spur.
It is typically around this time in the disease progression that the patient shows up for treatment. A complete physical examination and radiographic study will confirm one or more of these contributory symptoms of plantar fasciitis.
So will you be treating the symptoms or the true biomechanical cause of the plantar fasciitis?
Treatment plans including cryotherapy, gastrocnemius, soleus, and tibialis posterior rehabilitation, ultrasound, shock wave therapy and more may be effectively used to control acute pain and inflammation.
However, the real keystone of this program should be a complete biomechanical foot assessment with medial arch structural correction.
This inclusion will treat the true cause of the plantar fasciitis and reduce risk of recurrence.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.