Plantar fasciitis is a musculoskeletal disorder primarily affecting the fascial enthesis. Although poorly understood, the development of plantar fasciitis is thought to have a mechanical origin. In particular, pes planus foot types and lower-limb biomechanics that result in a lowered medial longitudinal arch are thought to create excessive tensile strain within the fascia, producing microscopic tears and chronic inflammation. However, contrary to clinical doctrine, histological evidence does not support this concept, with inflammation rarely observed in chronic plantar fasciitis. Similarly, scientific support for the role of arch mechanics in the development of plantar fasciitis is equivocal, despite an abundance of anecdotal evidence indicating a causal link between arch function and heel pain. This may, in part, reflect the difficulty in measuring arch mechanics in vivo. However, it may also indicate that tensile failure is not a predominant feature in the pathomechanics of plantar fasciitis. Alternative mechanisms including 'stress-shielding', vascular and metabolic disturbances, the formation of free radicals, hyperthermia and genetic factors have also been linked to degenerative change in connective tissues. Further research is needed to ascertain the importance of such factors in the development of plantar fasciitis.
The intervention may be beneficial for reducing the rate of falls in this patient population though further research with a larger sample size is indicated.
The sole of the foot acts as the interface between the ground and the body and is subjected to changing patterns of stress. These stresses will be accompanied by temporary or permanent strains within the tissues and may therefore be linked with those foot conditions which involve some degree of structural failure. One method of investigating the stresses is to measure the pressure distribution at the sole; an apparently simple task that continues to test scientific ingenuity and technological progress. Recent attempts to quantify shear stresses show that this extra goal may be even more challenging.
Previous reviews describe the technology but not the relationship between the sensor characteristics and the associated data. The apparent lack of understanding of this relationship is reflected in some published reports and has meant that clinical findings can be misinterpreted. This report reviews those sensor characteristics that have been recorded in the literature. It also shows how the sensor design influences the data and explains why a realistic appreciation of clinical findings requires a preliminary understanding of the chosen sensor.
Despite the implication that mechanical overload is fundamental to the development of plantar fasciitis, gait analysis has revealed inconsistent findings regarding its effect on lower limb loading. The aim of the current study was to evaluate the regional vertical ground reaction force in patients with and without plantar fasciitis. A pressure platform was used to determine the vertical ground reaction force beneath the feet of 16 patients with, and an equivalent number of patients without, unilateral plantar fasciitis while completing 10 gait trials at a self-selected walking speed. The magnitude and timing of ground reaction force for the entire foot and for the regions of the rearfoot, midfoot, forefoot, and digits were measured for each limb. The findings indicate that patients with plantar fasciitis make gait adjustments that result in reduced force beneath the rearfoot and forefoot of the symptomatic foot. In addition, increased digital loading was observed in patients with plantar fasciitis suggesting that digital function plays an important, and previously unidentified, protective role.
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