Role of plantar fascia in hallux rigidus

NewsBot · Sep 30, 2008

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A finite-element analysis study of the metatarsophalangeal joint of the hallux rigidus
R. Flavin; T. Halpin; R. O’Sullivan; D. FitzPatrick; A. Ivankovic and M. M. Stephens
Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 10, 1334-1340.

Hallux rigidus was first described in 1887. Many aetiological factors have been postulated, but none has been supported by scientific evidence. We have examined the static and dynamic imbalances in the first metatarsophalangeal joint which we postulated could be the cause of this condition. We performed a finite-element analysis study on a male subject and calculated a mathematical model of the joint when subjected to both normal and abnormal physiological loads.

The results gave statistically significant evidence for an increase in tension of the plantar fascia as the cause of abnormal stress on the articular cartilage rather than mismatch of the articular surfaces or subclinical muscle contractures. Our study indicated a clinical potential cause of hallux rigidus and challenged the many aetiological theories. It could influence the choice of surgical procedure for the treatment of early grades of hallux rigidus
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Admin2 · Sep 30, 2008

Related threads:
Reconceptualising FnHL as a disorder of variable stiffness of the first MPJ
First Metatarsophalangeal Joint Dorsiflexion Stiffness
Bending stiffness in the 1st metatarsophalangeal joint
Other threads on functional hallux limitus
Other threads on hallux rigidus
Other threads on finite element modelling

Craig Payne · Oct 1, 2008

NewsBot said: ↑

[The results gave statistically significant evidence for an increase in tension of the plantar fascia as the cause of abnormal stress on the articular cartilage
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Nice finding. I have not yet seen the full paper, but will have to dig it out.

Kevin Kirby · Oct 1, 2008

Glad to see confirmation of this fact that I (and Eric Fuller) have been writing about for some time.

Here is an excerpt from my July 2002 Precision Intricast Newsletter, "Modeling the Body to Explain Functional Hallux Limitus - Volume I" (Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002, pp. 141-142), where I discuss this concept of the importance of the plantar fascia in causing hallux limitus and also later discuss how the plantar fascia produces excessive hallux plantarflexion moments that cause functional hallux limitus.

When a restriction of hallux dorsiflexion occurs during the propulsive phase of gait, even though normal hallux dorsiflexion is present during non-weightbearing examination, then functional hallux limitus (FnHL) is said to be present. FnHL is caused by many factors with one of the most important factors in its production being the magnitude of tensile loading force present within the plantar fascia. Because plantar fascial tension is so important in the development of FnHL, it is critical to understand the mechanical factors that determine the magnitude of tensile loading force within the plantar fascia during weightbearing activities.
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NewsBot · Feb 8, 2019

The Role of Plantar Fascia Tightness in Hallux Limitus: A Biomechanical Analysis
Arnd F. Viehöfer et al
JFAS; Article in Press

Restriction of greater toe dorsiflexion without degeneration of the first metatarsophalangeal joint is defined as hallux limitus. We assume that in hallux limitus the limitation of greater toe dorsiflexion takes place in the terminal stance phase because of massive tightening of the calf and plantar structures. The current study investigated the role of a tight plantar fascial structure in impairing dorsiflexion of the greater toe. For the purpose of the study, 7 lower limbs from Thiel-fixated human cadavers were evaluated. To simulate double-limb standing stance, the tibia and fibula were mounted on a materials testing machine and constantly loaded with 350 N. Additionally, the tendons of the specimens were loaded using a custom-made system. The plantar fascia was fixed to a clamp and tensioned using a threaded bar. Four different tensile forces were then applied to the plantar fascia (approximately 100, 200, 300, and 350 N) and the extension of the first toe was measured. The results show a significant positive correlation between the decrease in extension of the hallux and the tension applied to the plantar fascia reaching a maximum mean decrease of 4.2° (117% compared with the untightened situation) for an applied tension of 364 N.
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