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Hi
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.

Regards

Is all about windlass mechanism. go forth and read ye student

http://www.podiatry-arena.com/podiat...ass-mechanism/

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Michael Weber

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See also:
Threads tagged with functional hallux limitus
Threads tagged with plantar fasciitis

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Is it?

http://www.sciencedirect.com/science...6d68bf7cc1d3ca

we also have:
http://www.sciencedirect.com/science...ed0719f2eb6 6

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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 ?

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Michael Weber

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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.

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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 ?

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Michael Weber

The most common thing about common sense is it´s not very common.

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Polly heres the 2 papers Ive mentioned (more reading)

Attached Files

	Plantar_fasciitis not inflammation but....pdf (282.6 KB, 48 views)
	the windlass mechanism of the foot.pdf (134.2 KB, 49 views)

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Michael Weber

The most common thing about common sense is it´s not very common.

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And there lies the question, is plantar fasciitis the result of excessive tension?

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God I hope so!!

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

Tension

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.

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Michael Weber

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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.

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.

Cheers,

Eric

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.

Eric

I tend to agree Eric, so how do we explain Keith Romes results?

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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.