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Plantar fasciitis and functional hallux limitus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by polly pod, Mar 10, 2010.

  1. polly pod

    polly pod Welcome New Poster

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    I am a new podiatry student, and am doing some research on plantar fasciitis. could anyone tell me if there is a link between plantar fasciitis and functional hallux limitus.

  2. Admin2

    Admin2 Administrator Staff Member

  3. Now your doing Polly Pods homework. In those 2 studies they did not mention anything about the windlass mechanism that I saw. While not trying to argue one way or the other I was trying to send Polly into some reading.

    And every time I think Ive got the windlass mechanism understood I tend to "learn from my mistakes", but did not Eric in his paper on windlass discuss the role of tension in the plantar fascia in Plantarfasciitis and Functional Hallux limitus, or more specically the medial band of the plantar fascia ?
  4. Mike, the Rome study questions the role of tension in the achilles, foot pronation and body mass as being significant in plantar heel pain. These factors should all influence plantar-fascial mechanics in relation to the windlass mechanism. The other systematic review, mentioned hallux dorsiflexion stiffness as a contributing factor.

    While Eric's paper provides an excellent theoretical discussion, it is just that, a theoretical discussion. The studies that have looked at patients would appear key.
  5. Ok far point about the studies I did go read them again. Thought you might say something.

    So to go thru this and I might be wrong in a few points.

    Theory- Plantar fasciitis/Fosciosis come from excesive tension in the plantar fascia. It can be over long periods in development or very quickly causing micro tears.

    Question to clinician?- What causes an increase in tension of the Plantar fascia.

    -Theory- tension in achilles, stj pronation and it many causes, non engagaed windlass (hope thats correctly termed),increased BMI etc.

    Question to researcher Whats causes an increase in tension of the Plantar fascia.

    Answer mechanical module say a,b,c, research with live subjects with Plantar fascia sysmptoms find that a,b,c has no contributing factors as why people have Plantar fascia pains.

    is that a fair summary?

    So then the next question is what leads to increase in tension of the plantar fascia ?

    Is it due to an increased external dorsiflexion moment of the forefoot against the rearfoot. ie the FF equinus patients with Plantar fascia pain, heel lifts work well alot of the time as the reduce this external dorsiflexion moment from GRF ?
  6. Polly heres the 2 papers Ive mentioned (more reading)

    Attached Files:

  7. And there lies the question, is plantar fasciitis the result of excessive tension?
  8. God I hope so!!

    Ok so what forces can be placed on the Plantar fascia to cause tissue stress?


    Compression in all direction ie compression from Ground and bone and I´m not sure on this but from distal towards proximal ( if that makes sense)

    I guess shear force would come under tension, but not sure again.

    anything else ?

    Mart going love this when he logs on, a big fan of Plantar fascia discussion is he.
  9. polly pod

    polly pod Welcome New Poster

    Thank you all so much for you help. I think a cup of tea is needed and a quiet sit down to read these journals. Thanks again.
  10. efuller

    efuller MVP

    I would say that the theoretical discussion is supported by those data from patients. There are other studies that say that particpation in atheletics, body mass index and limited ankle dorsiflexion are corelated with plantar heel pain. Theoretically, those factors would all lead to increase in tension in the Windlass. Those studies find correlations and we are just assuming that they are contributory.

    The study that there is correlation between those factors and tension in the plantar fascia because pain can change the gait. Those with active pain may walk in such a way to decrease tension in the fascia.


  11. efuller

    efuller MVP

    I still don't know what a non-engaged windlass is. It's pretty hard to put weight on the forefoot without being able to palpate increased tension in the fascia.

  12. I tend to agree Eric, so how do we explain Keith Romes results?
  13. james clough DPM

    james clough DPM Active Member

    There is more tension in the plantar fascia with a lower arch profile, mathematically. As the foot stabilizes and goes into a closed packed position, through dorsiflexion of the first MTPJ, the arch gets higher and tension will decrease through the plantar fascia. I see the first MTPJ more as a cam mechanism then a pulley and there reaches a breaking point with dorsiflexion where the tension gets less as the closed packed stable position of the arch is achieved.

    Without adequate DF of the first MTPJ there is tension in the plantar fascia all the time, never gets the cyclcal rest it needs.

    My opinion, yes, there is a correlation between stiffness of the first MTPJ and PF itis.

    The proof is in the results. Once ROM first MTPJ is restored clinically, symptoms often resolve quickly. Is the orthotic an exoskeleton stabilizing an unstable structure or is it enhancing foot function by improving first MTPJ motion and the stabilizing effects of the windlass mechanism? I think it should do both for maximum benefit to occur.
  14. dougpotter

    dougpotter Active Member

    These are two fantastic articles. Thank you.
  15. Kerrie

    Kerrie Active Member

    Hi There Polly,
    I actually did something similar to this for my dissertation all but minus the fhl, however I did look into it alot and can feel your pain, I also recently avulsed my fascia so I FEEL the patients pain haha. The study was a pilot into which is more effective pre fab or custom orthotics but if you PM me for my email I'll be happy to discuss my results with you and help you as much as I can :)
  16. NewsBot

    NewsBot The Admin that posts the news.

    Plantar Fasciitis and Its Relationship with Hallux Limitus.
    Yolanda Aranda and Pedro V. Munuera
    Journal of the American Podiatric Medical Association: May 2014, Vol. 104, No. 3, pp. 263-268.
  17. james clough DPM

    james clough DPM Active Member

    Good, this study brings clarity to the relationship between motion of the first MTPJ and PFasciitis. The two are intimately connected and I see this in my patient population consistently. These people are not propulsive over the hallux and shuffle during gait. The open-packed foot position this entails puts great stress on the PF as there is no inherent stability of the medial longitudinal arch. Restoration of this stability, through Hallux dorsiflexion is necessary to relieve stress on the fascia.

    Key to any intervention is to allow dorsiflexionof the first MTPJ to occur without significant resistance, and restore a normal propulsive gait pattern.

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