I'd love a copy of the paper if anyone has it.
The wording seems a bit odd.
You'd think there would be more than 5 times tension in fascia at heel strike vs. push off.
At heel strike, with the forefoot in the air, the only thing loading the fascia would be the ant. tibial muscle.
At forefoot loading, I would expect a peak.
I wonder if that's what they meant.
Hi All
I have an interest in plantar fasciopathy and am considering undertaking some study in the near future. Has anyone looked at it from degenerative enthesopathy view- managing it as a 'failed healing response' with a graded loading programme? There are some thoughts about the role of compression in sick tendons- are there any indications that there might be subgroups where compression eg some form of 'cam' effect from the calc, is relevant? I.e- is it always about tension?
To that end, I might expect that there are different mechanical subgroups within PF, that respond to different interventions. I expect some will hate loading, but clinically, others do well with it? Leads me to another question, and that is the (natural history) expectation that the condition 'burns out' within 12 months. Any good studies which actually measure physical outcomes in recovered subjects?
Cheers
JasonR
Anatomy and Biomechanical Properties of the Plantar Aponeurosis: A Cadaveric Study
Da-wei Chen, Bing Li, Ashwin Aubeeluck, Yun-feng Yang, Yi-gang Huang, Jia-qian Zhou,
Guang-rong Yu PLoS ONE 9(1): e84347. doi:10.1371/journal.pone.0084347
Is there really a difference or is it just semantics?
I just happen to have Myers (Anatomy Trains) & Schiepi et al (Fascia:The tension network of the human body) on my desk ... neither of them shed much light on the difference.
The differentiation as I understand it Craig is that an aponeurosis is defined by the longitudinal alignment of the type 1 collagen fibres, whereas a fascia has multilayered and multidirectional fibre orientation.
"the plantar fascia has received more attention
from the biomechanical engineers and clinicians than from
anatomists. This is evident also analyzing the anatomical
terminology. In the Nomina Anatomica (1998) only the term
plantar aponeurosis is used to indicate this structure, but it
is inserted in the chapter ‘fasciae’. In the various anatomical
textbooks, the terms ‘plantar fascia’ and ‘plantar aponeurosis’
are used interchangeably. In fact, the term ‘aponeurosis’
is generally used to indicate a tissue with a unidirectional
arrangement of collagen fibers, whereas a fascia is a structure
with a multidirectional arrangement of the fibers
(Langevin & Huijing, 2009). No published works have discussed
which term is more appropriate for this tissue and
it is not clear whether the PF contains only longitudinal
or also multidirectional fibers. In our microscopic study,
different stains were used to reveal the arrangement and
composition of the plantar fascia: the collagen fibers were
found arranged mainly in a proximal-to-distal longitudinal direction, but there were also various fibers lying in vertical,
transverse and oblique directions. This multilayer configuration
of the collagen fibers is a typical feature of fasciae
rather than aponeurosis, so we suggest that the term ‘plantar
fascia’ would be a more appropriate name for this tissue."
paper attached for those interested.
Sarrafian calls it the plantar aponeurosis and divides it into the central component, medial component and lateral component.
What's the better word?
I think the three components of the plantar aponeurosis (Sarrafian's term) are the most accurate way of discussing this structure.
Here is the photo I use in my lecture on the 10 Functions of the Plantar Fascia.
When the going gets tough, one goes back to basics. The deep fascial tube invests the whole body, though certainly with modifications in places eg Scarpa's Fascia and its relationship to the abdominal fascia as a whole. An aponeurosis, on the other hand, is generally defined something like this: "a broad band of fibrous tissue, other than a tendon, that joins muscle to bone". Thus the iliotibial tract is an aponeurosis - joining (most of) gluteus maximus and tensor fascia lata to the lateral tibia; it is thus an augmentation of the fascia lata, the deep fascial tube of the thigh. Palmaris, in the flexor/pronator compartment of the forearm, inserts into the palmar fascia. And in the foot? Well, just as everywhere else, the whole foot is sheathed with deep fascia, which plantarly may be called the plantar fascia. However the plantar aponeurosis is correctly a subset of this - highly modified for specialist function which we all know about. But if an aponeurosis has a muscular insertion - what about this example? It used to
- the plantaris muscle inserts into the plantar aponeurosis in many species, including some primitive primates - essentially those species that keep there calcaneus off the ground, like my dog.
I accept, these days, its all in a name, but correctly, that is the proper nomenclature. Rob
Interestingly I have just marked a Masters Thesis from a university that you have all heard of, on among other things, the plantar fascia. I expect it to be in the press by the end of the year.