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Im a second year student at salford uni and im getting a bit confused! Im reseaching the sagittal plane theory in relation to the diagnosis and treatment of plantar fasciitis compared to the tissue stress theory, i have found lots of information on both theories but am struggling to pinpoint the treatment of plantar fasciitis in the sagittal plane , please help!

regards caron

 

:welcome:

Hi - welcome to Podiatry Arena. I notice you haven't had any replies to your query - I suggest reposting it in the biomechanics forum as not everyone looks at the introductions forum that often. Good luck

 

Hi Caron,

Use of a heel lift will take the tension out of the plantar fascial/gastroc tract.

Another approach is to employ an antipronatory orthotic shell and cut out a slot for the first ray to allow full plantarflexion and utilise all of the ginglymoarthrodial movement of the 1st mpj. This minimises the amount of extra dorsiflexion movement that has to be found at toe-off at the 1st mpj and thus reduces the tension on the plantar fascia that Hick's windlass mechanism would otherwise impose. Both of these strategies operate in the sagittal plane. They could be used separately or in combination.

Antipronatory orthoses without cut-outs will relieve tension on the plantar fascia by preventing elongation of the medial columns, but this might be considered to be a partly frontal plane strategy.

 

Hey Caron

I think I know why you are confused. I fear you are working from a flawed premise. Tissue stress theory covers saggital plane theory as well.

For eg. What is the role of the plantar apeurneurosis? Partly to resupinate the foot at heel raise as per the windlass effect right? So you can reduce the amount of strain on the plantar fascia by reducing the amount of force needed to resupinate the foot. One way to do that is to plantarflex the first met. To plantarflex the 1st met you can do one of two things. 1. Raise the base of the met (arch support) or 2, drop the head of the 1st met (kinetic wedge / reverse mortons extension).

They are both tissue stress interventions. Both increase hallux plantarflexion (which, of course is in the sag plane). Therefore both are tissue stress interventions AND sagittal plane interventions.

For some reason however, 1 is seen as a "frontal plane" modification and the other a "sagittal plane" modification. In fact they are both triplanar modifications, both based on tissue stress theory and both work by adjusting the function of the windlass, which operates almost entirely in the sagittal plane.

Clear now;)

Regards
Robert Isaacs

 

Thanks everyone for your help ...... it has helped to clear a few issues.

Caron