Biomechanical Consequences of Plantar Fascial Release or Rupture During Gait: Part I - Disruptions in Longitudinal Arch Conformation

Abstract

To examine whether conformational changes induced by plantar fascial division may progress during gait, we loaded the feet of seven cadavers using an apparatus that simulates the actions of the extrinsic plantarflexors. We measured the effects of plantar fasciotomy at two instants in the terminal-stance phase of gait. Radiographic measurements of height of the arch, base length of the arch, and talo first-metatarsal angle were used to assess contributions to arch support made by the plantar fascia, tibialis posterior, peroneus longus and brevis, and digital flexor muscles. Complete fasciotomy caused significant collapse of the arch in the sagittal plane. Early in terminal stance, at the instant after heel-off, mean height of the arch decreased from 47 to 45 mm. Late in terminal stance, at the instant preceding contralateral heel strike, mean height of the arch decreased from 46 to 43. Effects of division of the central band, though significant, were mild. Medial base length of the arch increased from 163 to 167 mm in the absence of tibialis posterior contraction at late terminal stance. Arch-supporting abilities of the other extrinsic muscles were insignificant.

Apparent density of the primate calcaneo‐cuboid joint and its association with locomotor mode, foot posture, and the “midtarsal break”

“…Structural competency of the longitudinal arch is therefore critical in humans. Indeed, clinical work has outlined numerous risk factors associated with the surgical release of the plantar aponeurosis, including a decrease in arch height (Kim and Voloshin, 1995;Kitaoka et al, 1997;Sharkey et al, 1998) and altered stress distributions in hard (i.e., calcaneocuboid joint and metatarsals) and soft (i.e., spring ligament, short plantar ligament, long plantar ligament, flexor digitorum longus, and flexor hallucis longus) tissues (Murphy et al, 1998;Gefen, 2002;Crary et al, 2003;. A well-developed human plantar aponeurosis contributes to propulsion by rapidly transmitting forces from the hind foot to the forefoot via elastic recoil of the ''preloading'' and peakloading phases (Hicks, 1954;Wright and Rennels, 1964;Bojsen-Møller, 1979;Ker et al, 1987;Simkin and Leichter, 1990;Pataky et al, 2008;Caravaggi et al, 2009).…”

Treatment of Resistant Planter Fasciitis: Comparsion of Three Techniques

“…Significant collapse of the arch in the sagittal plane was reported by Sharkey, et al [22] with a complete fasciotomy. Sharkey, et al [22] also in a follow up study found that cutting only the medial half of the plantar fascia did significantly increase peak pressure under the metatarsal heads with little effect on pressures in other regions of the forefoot or second metatarsal strain and loading. Significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads and increased strain and bending in the second metatarsal caused by dividing the entire planter fascia.…”

“…Weakness of the medial longitudinal arch and pain in the lateral midfoot in cadaver specimens with a total release was repored [21]. Significant collapse of the arch in the sagittal plane was reported by Sharkey, et al [22] with a complete fasciotomy. Sharkey, et al [22] also in a follow up study found that cutting only the medial half of the plantar fascia did significantly increase peak pressure under the metatarsal heads with little effect on pressures in other regions of the forefoot or second metatarsal strain and loading.…”

One portal endoscopic treatment in plantar fasciitis: preliminary results of a prospective study

“…En effet, cette section, partielle ou complète du fascia plantaire, conduirait progressivement à un pied plat, même avec une section limitée selon Sharkey et al [15]. Le fait de sectionner le fascia entraînerait une modification de conformation de l'arche plantaire.…”