Effect of improved windlass on Plantar facia

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I am a Cert. Pedorthist making my first post on this forum, although I am a long time reader.

Here is my question. I have a patient referred to me by a local Dr. for some orthotics fabricated to the same specs as he has had before that have had only marginal effect, a particularly hard case.

The patient presents rearfoot valgus, ltd. subtalar Rom, ltd. ankle dorisflexion, and what I suspect is some aquired forefoot varus.

Anecdotally I have found that a first ray drop as specified by other doctors is helpful in this type of case.

I want to suggest this to the referring doctor but would like to understand the mechanisim involved in which improved windlass reduces plantar facia stress.

I know the answer is in here somewhere but after an hour I could not find a satisfactory description.

Thanks for your time, and please go easy on me!

Jeff

 

Welcome Jeff.

One reason that some of us may seem hard on other posters is that we may seem critical when we don't quite understand the new posters terminology. Often, it seems the new poster doensn't understand the terminology either. So, we have to start with the definitions. What is an improved windlass? What I interpret that as is a decreased effort, by the examiner, to dorsiflex the hallux when the patient is in stance. I'd prefer folks say that rather than say improved windlass. So, if you understand the anatomy, and function, of the windlass it should be obvious as to why when it's easier to dorsiflex the hallux in stance that there would be less stress on the plantar fascia. The fascia is the structure that creates the plantar flexion moment that resists the attempt at dorsiflexion by the examiner. The tighter (more force in) the plantar fascia the greater the plantar flexion moment on the hallux.

First ray drop. Again definitions are important. This sounds like what I call a reverse Morton's extension. Which is a piece of cork, or some other material, under metatarsal heads 2 through 5. An extension is usually glued to the underside of the top cover just distal to the end of the orthotic. The idea behind this is that you decrease dorsiflexory moment on the first ray. The plantar fascia (windlass) resists dorsiflexion of the first ray. The greater the dorsiflexion moment on the first ray the greater tension there will be in the plantar fascia.

Hope this helps,

Eric

 

Re: Effect of improved windlass on Plantar facia

Thank you Eric,
That's the information I was looking for.
As the hallux dorsiflexes with greater ease in gait, due to a reverse Morton' extension, there is less tension on the plantar facia.
Really appreciate it!
Jeff --------------------------------------------------------------------------------