Plantar fasciitis is the most common cause of heel pain. It involves inflammation of the plantar fascia, a thick band of connective tissue running along the bottom of the foot. While some believe that tight calf muscles or heel spurs can cause plantar fasciitis by increasing tension on the plantar fascia, the true causes are debated. The spring-mass model of locomotion, which views the leg as a spring, may better explain plantar fasciitis than models involving stiff legs or tight muscles alone. Prevention focuses on proper footwear and avoiding prolonged standing.

2. Plantar Fasciitis
Plantar Fasciitis is the most common
cause of heel pain in adults.
Plantar Fasciitis
Top 10 most common
conditions of the lower body
1. Patellofemoral Pain Syndrome
2. Iliotibial Band Friction
Syndrome
3. Plantar Fasciitis
4. Meniscal Injuries Of The Knee
5. Tibial Stress Syndrome
6. Patellar Tendonitis
7. Achilles Tendonitis
8. Gluteus Medius Injuries
9. Stress Fracture Tibia
10. Spinal Injuries

3. Plantar Fasciitis AKA
• Plantar fasciitis is often called “heel spurs,” although
this terminology is somewhat of a misnomer because
15 to 25 percent of the general population without
symptoms have heel spurs and many symptomatic
individuals do not. (9)
• The other names for plantar fasciitis are plantar
fascitis, plantar fasciosis, fasciitis plantaris, plantar
fascial fibromatosis, plantar heel pain syndrome,
policeman's heel, heel spur syndrome, painful heel
syndrome, and inferior calcaneal exostoses.

4. Relationship to Heel Spurs
Around 50 percent of
patients with plantar
fasciitis have heel spurs,
but they are most often
an incidental finding and
do not correlate well with
the patient's symptoms. (8)

5. What is Plantar Fasciitis?
• It is by definition, a painful inflammation of
the plantar fascia.
• It is an abnormality or injury at the site of
attachment of a ligament or tendon to bone)
of the origin of the plantar fascia at the medial
tubercle of the calcaneus due to excess
traction often characterized by pain on the
first step in the morning (2) or when they
stand up after prolonged sitting. (1)

6. Incidence
• Plantar fasciitis is the most common cause of
heel pain with ten percent of the population
will pull up with plantar fasciitis in their
lifetime. (5)
• The condition accounts for eleven to fifteen
percent of all foot symptoms, affecting two
million people in the United States alone. (4)

7. What are the symptoms of
plantar fasciitis?
• The tenderness you would feel is usually noted on the medial
calcaneal tuberosity (see image) and along the plantar fascia. The
classic sign or plantar fasciitis is pain on first few steps in the
morning. The pain usually decreases after you walk it off, but can
return throughout the day the longer you are on your feet.
• Most feel the symptoms of pain when standing on feet too long.
The pain can come on worse at the end of the day. Its more
common and more severe in those who are overweight, obese or
weakness in specific muscles of the foot.
• The pain often increases with stretching of the plantar fascia, which
is achieved by lifting your foot (dorsiflexion) and toes up. (8)

8. Causal Connection to Heel Spurs
• Fuller stated that fascial stretching caused pain either to the plantar
fascia itself or at the attachment to the bone. High tension in the
fascia could also cause a periosteal lifting at its insertion on the
calcaneus, and bone healing could cause growth of a spur that
might be seen at the calcaneus. (61)
• Plantar fasciitis is generally believed to be due to repetitive partial
tearing at this enthesis with associated chronic inflammation. (2)
• These results support the belief that pain occurs not from the bone
spur but from the excessive tension applied to the plantar fascia (11)

9. Doesn’t Plantar Fasciitis
Only Effect Athletes? No!
• Plantar fasciitis is usually seen as an overuse injury in athletes, runners in
particular (accounting for nearly 10% of running injuries), but is also seen in non
athletes too. (3)
• Most non-athletes have it in the subclinical state, which means that there is
inflammation of the fascia but not enough to cause pain you can feel unless you
press into the fascia called deep tissue palpation.
• If non-athletes have this form of non painful inflammation of the fascia and walk a
few blocks barefoot or run with or without shoes they will feel the pain in their
fascia as the inflammation rises to a point where the nerves and brain together
sense the higher concentration of inflammation.
• I check the plantar fascia and the health of the feet for all conditions because I feel
the status of the foundation of our body or the bodies spring suspension system

10. What Causes Plantar Fasciitis?
• Plantar fasciitis is one of the more common soft-tissue
disorders of the foot, yet little is known about its
etiology.
• The fascia foot pain is caused by stress and strain in the
area, that leads to the release of inflammation and
when the inflammation gets high enough you feel pain.
• Although the pathology of plantar fasciitis is
understood the development or causes of plantar
fasciitis is less agreed upon.

11. What Causes Plantar Fasciitis?
• Also, although plantar fasciitis
is a prevalent problem, little
scientific evidence exists
concerning the most
appropriate treatment
approach or intervention. (3)
• Why?
• Because doctors cannot agree
on the cause of plantar fasciitis
it makes it difficult for
physicians to diagnose and
treat this common injury.
• I explain why in this
presentation

12. Three Schools Of Bio-Mechanics
• Inverted Pendulum Model – and The Lever
Series Model (1685)
• The Spring- Mass Model (1989/1990)
• The Integrated Spring-Mass Model (2012)

13. Borelli Giovanni Alfonso 1680
Inverted Pendulum & Lever Model
• De Motu Animalium, Pars prima or
On the movement of animals
• In his seventeenth century volume
‘De motu animalium’, Borelli
discussed walking as vaulting over
stiff legs using a pair of compasses
and noted the importance of
rebounding on compliant legs in
running (97).
• From that early account up to the
present, walking and running have
been treated as different mechanical
paradigms, and the two
corresponding models, the inverted
pendulum model for walking (5) (98)

14. Spring-Mass Model
Blickhan 1989; McMahon & Cheng 1990
Harvard University
• The planar spring-mass
model is a simple
mathematical model of
bouncing gaits, such as
running, trotting and
hopping (105)

15. Inverted Pendulum vs Spring-Mass
Geyer H., Seyfarth A., Blickhan R. 2006 (13)
•
• Recent modeling analysis has shown that Inverted Pendulum applies well to walking
• The basic mechanics of human locomotion with the Inverted Pendulum model are associated with vaulting over
stiff legs in walking and rebounding on compliant legs in running.
• However, while rebounding legs well explain the stance dynamics of running, stiff legs cannot reproduce that of
walking.
• With a simple bipedal spring-mass model, we show that not stiff but compliant legs are essential to obtain the
basic walking mechanics
• We argue that not stiff but compliant legs are fundamental to the walking gait.
• In fact, they concluded the spring-mass model was best for describing the walking gait
• With a simple bipedal spring-mass model, we show that not stiff but compliant legs are essential to obtain the
basic walking mechanics; incorporating the double support as an essential part of the walking motion, the model
reproduces the characteristic stance dynamics that result in the observed small vertical oscillation of the body and
the observed out-of-phase changes in forward kinetic and gravitational potential energies.

16. Spring-Mass Model
vs
Integrated Spring Mass Model
• The Spring-Mass Model
embodies that during
walking and running,
the whole leg were a
linear spring. (15)
• The Spring-Mass Model
models the legs as
springs and the torso as
the mass

17. Spring-Mass Model
vs
Integrated Spring Mass Model
• Integrated Spring-Mass
Model suggests the legs are
the combination of a
Progressive Rate Spring and
Torsion Spring
• This new model models the
legs as Progressive Rate
Torsion Springs the body as
a Progressive Rate Spring
and Torsion Spring.
• The head is the only mass

18. Spring-Mass Model
vs
Integrated Spring Mass Model
• Lever Defined:
A simple machine
consisting of a bar that
pivots on a fixed support,
or fulcrum, and is used to
transmit torque. A force
applied by pushing down
on one end of the lever
results in a force pushing
up at the other end.
• Spring Defined:
In classic physics, a spring
can be seen as a device
that stores potential
energy, specifically elastic
potential energy, by
straining the bonds
between the atoms of an
elastic material.

19. Inverted Pendulum Model vs Spring-Mass Model

20. Spring-Mass Model

23. Potential Energy of Springs

24. Plantar Fasciitis
Examination, Treatment and Prevention
Inverted Pendulum/Lever Series Approach
vs
Integrated Spring-Mass Approach
How do they differ?

25. Inverted Pendulum/Lever Series Approach
• Many “lever model only” thinkers believe we ambulate
with levers in linkages.
• That is why they are validated when they note the
symptom of pain in the fascia when we have tension on the
Achilles tendon through the gastroc/soleus muscle
contraction. (2)
• Unfortunately, “Pendulum-Lever model only” thinkers cant
provide much of an explanation for how the mechanism
breaks down to cause the stress on the plantar fascia.
• They have few theories

26. Inverted Pendulum/Lever Series Approach
• the human lever model says that the primary
reason for why the fascia has stress is because
of a tight fascia due to a tight Achilles.
• I have never found the Achilles tight in one of
the patients I have examined with plantar
fascia in my life.

27. Why Tight Achilles is
Not a Cause of Plantar Fasciitis
1. The Achilles is not a contractile element
1. The plantar fascia has no contractile
elements.
2. There is no research that shows increased
electrical activity in the Achilles muscle group
coincides with plantar fasciitis (no proof)

28. Lever Series says
Tight Achilles is the Cause?
• For example: the human lever
model says that the primary
reason for why the fascia has
stress is because of a tight
fascia due to a tight Achilles.
• I have never found the Achilles
tight in one of the patients I
have examined with plantar
fascia in my life.
• No biomechanical explanation
why Achilles Tendon Muscle
group is Tight or in Spasm in
the Scientific Literature.

29. Primary Cause
• Standing on your
feet too long

30. Spring Elastic Recoil
Spring Suspension Muscles

31. The Effect Of Flip-flops On Dorsiflexion
and Tibialis Anterior Electromyography.
• The study also showed that female subjects had a
more vertical attack angle in flip-flops when
compared to athletic sneakers
• Specifically, as the non-support leg swings through,
the tibialis anterior (TA) demonstrated an increase
in muscle activity, yet less dorsiflexion (DF) was
noted compared to barefoot walking.
• This finding was counterintuitive, as the TA is a
primary dorsiflexor, and more activity should have
been realized with an increase in dorsiflexion.
• the counterintuitive finding of increased dorsiflexor
muscular activity and less observed dorsiflexion
angle leads the author to conclude that the
increased activity of the TA in the presence of less
dorsiflexion could be the result of the flip-flop
wearer’s attempt to “grip” the flip-flop using the
plantar surface of the foot.
• Reciprocal inhibition, Internal Compressive Forces -
Bang and Twist Plantar Fasciitis and Shin Splints

32. • In addition to decreased dorsiflexion
during the swing phase of gait, the
activity of the toe flexors to “grip” the
flip-flop may also affect the windlass
mechanism of the foot. The windlass
mechanism functions in the foot as
the first metatarsophalangeal (MTP)
joint extends. As the 1st MTP joint
extends, the plantar fascia tightens.
This tightening of the plantar fascia
has two functions; (1) the medial
arch of the foot is packed tighter and
is increased in height, allowing for
improved loading capacity and shock
absorption
• The foot becomes more rigid and has
improved function as a propulsive
lever

33. If Spasms or Tight Achilles then..
• If the cause of plantar fasciitis is spasms or tightness in the Achilles
Tendon Group then how does this relate to the normal cause which
is standing on the feet too long?
• If the cause of plantar fasciitis is spasms or tightness in the Achilles
Tendon Group then you should find trigger points or muscle spasms
in the area.
• If tension in the Achilles then the plantar fascia would still pull only
harder and the windlass mechanism would still work because the
fascia is connective tissue and not muscle.
• It doesn’t make sense!

34. Achilles Spring
The gastrocnemius and soleus do not push the body forward when walking or running – They spring it
forward
• An average of 38 J of energy was recovered from the elastic recoil of the tendon, which contributes
16% of the total average mechanical work of the hop (254 J). (65)
• In conclusion, the properties of the elastic Achilles tendon can contribute significantly to the total
mechanical work of the body during one-legged hopping; however, individual variation in the
properties of the tendon vary the energy storing capacity of this structure. (65)
• The results indicated that the AT does indeed act like an energy storing spring by contributing a
considerable amount of energy to the total mechanical work performed. (65)
• The results of this study demonstrated the energy storing capabilities of the AT, whereby the
tendon stretches in proportion to the force applied during the downward motion of the body and
then recoils to release most of the energy stored (74%) during the upward movement. This
provides a substantial amount of the total mechanical energy of the hop (16%). (65)

35. More Evidence of Spring vs Push
• This study we investigated in vivo length changes in the
fascicles and tendon of the human gastrocnemius
medialis (GM) muscle during walking.
Two important features emerged:
• the muscle contracted near-isometrically in the stance
phase, with the fascicles operating at ca. 50 mm; and
• the tendon stretched by ca. 7 mm during single support,
and recoiled in push-off.
The spring-like behavior of the tendon indicates storage and
release of elastic-strain energy

36. What is the plantar fascia?
• The plantar fascia, also known as the plantar aponeurosis is a broad, flat, fibrous,
tendon-like structure, which consists of non-contractile irregularly ordered collagen
fibers with minimal elastic properties. (13)
What does that mean?
• What that means is that it is like gristle on a steak.
• It means it doesn’t stretch much.
• It means it does not contract like a muscle.
What roll does it play?
• The plantar aponeurosis plays an important role in transmitting Achilles tendon
pull forces to the forefoot when you are about to push off when you walk. (46)

37. Basis of Lever Model Treatment
• There is an indirect relationship whereby if the toes
are dorsiflexed, the plantar fascia tightens via the
windlass mechanism. If a tensile force is then
generated in the Achilles tendon it will increase
tensile strain in the plantar fascia. Clinically, this
relationship has been used as a basis for treatment
for plantar fasciitis, with stretches and night stretch
splinting being applied to the gastrocnemius/soleus
muscle unit. (18)

38. This is what the lever model thinkers
say causes plantar fasciitis
• Increasing tension on the Achilles tendon is coupled
with an increasing strain on the plantar fascia.
Overstretching of the Achilles tendon resulting from
intense muscle contraction and passive stretching of
tight Achilles tendon are plausible mechanical
factors for overstraining of the plantar fascia. (24)
• What is causing the overstretching or strain on the
Achilles and fascia is the magic question to solving
this riddle

39. Cause
• Series-elastic springs
• Direction and timing of the
flow of energy
• How can the fascia be the
issue when it doesn’t have a
contractile element to it?
• How can the achilles be the
problem when its tension
isnt effected by muscle
spasms?
• As a lever, at pushoff when
it pushes you would expect
it to elongate more so why
doesn’t it?

40. cause
• How does standing on your feet too long cause
any effect on the achilles tendon?
• If the arch collapses the achilles tendon slackens

41. Slow Motion Video of Loading
• If the tibialis posterior
muscle is cut the result is
adult flat foot deformity. So
why is the plantar
aponeurosis responsible for
raising the arch of the foot
• If the dissent of arch of the
foot is controlled by the
tibialis posterior then why
isnt the tibialis posterior
responsible for raising of
the arch of the foot?

42. Cause: Preloading by Dorsiflexors
• The results show that the PA experienced
tension significantly above rest during early
stance phase in all subjects (P<0.01), thus
providing support for the PA-preloading
hypothesis. (128)
• In contrast to their finding, however, in this
study the PA appeared to be pre-loaded at
heel-strike. (128)
• The simultaneous action of the ankle
dorsiflexors and toe extensors, which prevent
foot-slap and dorsiflex the toes at the MTPJ,
and the plantarflexion moment applied to
the calcaneus by the vertical ground reaction
forces could account for some pre-stretching
of the PA. (128)
• A MTPJ dorsiflexion angle of about 30 deg.
was measured for the three subjects thus
confirming the action of the toe dorsiflexors
at and prior to heel-strike. (128)

43. Slow Motion Video Of a Gait with
Preloading Of Dorsiflexors

44. • further experimental and/or
modelling studies, we can only
speculate as to the possible
advantages of such preloading.
Loading the PA at heel-strike is
likely to reduce the crimp
present in unloaded
collagenous tissues (132)
• thereby resulting in earlier
arch stiffening and helping to
ensure that, as the propulsive
phase begins, a greater
proportion of force is
transferred by the foot to the
ground. (128)

45. Windlass Effect
• During dorsiflexion of the toes, as
occurs in late stance, the PA is
stretched as it wraps around the
MH. This is the so-called windlass
mechanism which, in the late
phase of stance, is responsible for
raising the arch of the foot. (130)
• and contributing to stiffening of
the foot by pulling on the heel,
causing inversion at the subtalar
joint and `locking' the midtarsal
joint (131)

46. What Suspends The Load Of The Arch
Off The Plantar Fascia?
• Throughout the literature
you see contradictions.
• For instance one paper says
that the plantar fascia
prevents foot collapse by
virtue of its anatomical
orientation and tensile
strength.
• One biomechanical model
estimated it carries as much
as 14% of the total load of
the foot.
• What holds up the rest?

47. Windlass Effect

48. • In this paragraph again the
treatment is to the plantar
fascia. We have to address
this enemy as it has
wronged us. In reality the
plantar fascia has done no
wrong. In fact it is a victim
being stressed because
other structures that assist
the fascia by suspending the
remaining 86% of the load
off the fascia haven’t been
doing their job to keep the
load off the fascia.

49. How do lever doctors diagnose?
Video of examination of arch joint play
• Palpation
• Ultrasonography (37)
(38) (39)
• Doctors may use MRI to
see the total volume of
plantar intrinsic foot
muscles to see if they are
smaller on the involved
side. (42)
• If they are then it could
be that the joints they act
on are locked preventing
contraction?

50. How do spring-mass model diagnose
video of gait at all speeds
• Advanced Video Gait
Evaluation Study at all
force increments
• Double leg
• Single leg
• Walking
• Fast Walking
• Jogging
• Running
• Plyometrics

51. Response to Traditional
Lever Based Treatment Approaches
• (44%) respondents
favored initiation of
plantar fascia-specific
stretching (PFSS)
• (24%) supervised physical
therapy
• (20%) night splinting
• (6%) steroid injection –
(4%) custom orthotics
• (2%) cast or boot
immobilization (70)

52. Lever Model Therapy
• Conservative care
(chiropractic therapy,
electric modalities)
• Patient education, soft
tissue therapy/massage,
acupuncture, taping, night
splints, stretching, ice, heat,
strengthening, orthotics)
• Extra-corporeal shock wave
therapy
• Injections and medication
• Surgical intervention (70)

53. Stretching
• First, how can the plantar fascia tighten
when it is a non-contractile tissue?
• Why would anyone recommend stretching
connective tissue just because it is strained?
• They think it is tight from being too short.
How did it get so short with the excess
weight on it?
• It cannot tighten because it is not a muscle.
You will find out later that this is the opposite of
what you do. In fact stretching of an already
overloaded strained tissue could increase its risk
for tearing.
•

54. Taping
• Taping provides only
transient support, with
studies showing that as
little as 24 minutes of
activity can decrease
the effectiveness of
taping significantly. (88)

55. Orthotics
• The aim of orthotic therapy
is to reduce strain on the
plantar fascia by cushioning
and elevating the heel
and/or providing medial
arch support.
• Orthotics may also be useful
for overweight plantar
fasciitis patients, as they
help to reduce shock and
cause more even weight
distribution over the plantar
fascia and its insertion on
the calcaneus (90)

56. • Also if there is too
much stress on the
plantar fascia isn’t it
from the structures that
hold up the arch 86%
that are weak that we
need to address?

57. Adjustments and stretching vs
orthotics
Video of Adjustment of arch
• As mentioned previously, the study by Dimou, Brantingham
and Wood of chiropractic adjustments/manipulation of the
foot and ankle along with a daily stretching regimen). (94)
• The custom orthotics group reported significant
improvements in almost all outcome measures, but these
improvements were not statistically different or superior to
those obtained in the chiropractic and stretching group. (94)
• Dimou et al reported a significant difference for pain between
the manipulation treatment group and the CFO treatment
group, with the chiropractic group being superior. (94)

58. Night splints
• Night splints usually are designed to
keep a person's ankle in a neutral
position overnight.
• Most individuals naturally sleep with
the feet plantar-flexed, a position
that causes the plantar fascia to be in
a foreshortened position
• A night dorsiflexion splint allows
passive stretching of the calf and the
plantar fascia during sleep
• Disadvantages of night splints include
mild discomfort, which may interfere
with the patient's or a bed partner's
ability to sleep. (99)
• How can fascia stretch when it is not
a muscle?

59. Cortisone injections
• All of the patients found the corticosteroid
injection painful. The post-injection pain was
said to have continued for a mean duration
of 5 and 7 days respectively (101) (105)
• This pain in the injection site can lead to an
abnormal gait. Walking with a stiff painful
foot causing a limp can alter foot
biomechanics or your pattern of walk and
make your plantar fasciitis worse.
• Lee and Ahmad’s study reported the
corticosteroid group to show a significant
reduction in pain on the visual analog scale
at both 6 weeks and 3 months in comparison
to the autologous blood group.
• However, this change was not significant at 6
months. (105)
•

60. CORTISONE INJECTIONS
Georgia Baptist Medical Center, Atlanta,
1992 to 1995
• The authors injected 122 of the
765 patients, resulting in 12 of
the 44 plantar fascia ruptures.
Subjective and objective
evaluations were conducted
through chart and radiographic
review.
• Thirty patients (68%) reported a
sudden onset of tearing at the
heel, and 14 (32%) had a gradual
onset of symptoms.
• At an average 27-month follow-
up, 50% had good/excellent
scores and 50% had fair/poor
scores

61. CORTISONE INJECTION
• The risk factors for the use of CSI include plantar
fascial rupture, hypoglycemia in diabetic patients,
skin and fat-pad atrophy, and sepsis. These findings
suggest that treatment regimens such as serial
corticosteroid injections into the plantar fascia
should be reevaluated in the absence of
inflammation and in light of their potential to induce
plantar fascial rupture. (106)

62. BOTOX
• Reserve for chronic injuries, after intensive use of other approaches for at least 2 months has failed
• Use when rehabilitation is inhibited by symptoms
• Informed consent should be obtained from the patient, who must be willing to follow postinjection
guidelines
• The practitioner should have full knowledge of the local anatomy
• Select the finest needle that will reach the lesion
• The practitioner's hands and the patient's skin should be cleansed and a no touch technique used
• Use short or medium acting corticosteroid preparations in most cases, with local anaesthetic
• Injection should be peritendinous; avoid injection into tendon substance
• Minimum interval between injections should be 6 weeks
• Use a maximum of three injections at one site
• Soluble preparations may be useful in those patients who have had hypersensitivity/local reaction to
previous injection
• Details of the injection should be carefully recorded
• Do not repeat if two injections do not provide at least 4 weeks' relief (107

63. ORTHOTICS WHY DON’T WORK
• By placing a support under the arch it could inhibit full depth of
loading of the arch in its descent. You have a shoe which causes
a compressive force on the arch and fascia from the top and the
arch support occupying space at the bottom. If the arch must
raise up to accommodate the windlass effect there is a
possibility that the windlass effect could be sabotaged or
reduced. This could place more stress on the plantar fascia.
• A binding device can possibly restrict the mobility of the loading
and rolling. If there is restrictiuon of movement there is
reduction in maximum muscle contraction and relaxation. This
could inhibit the adaptation strengthening of the intrinsic and
spring suspension system muscles.
•

64. 10 months no relief – Surgery or
ECSWT
• What was the surgeon's preferred treatment after 10
months of non-responsive to treatments. (70)
•
• 62 (74%) respondents chose surgery or ECSWT
(extracorporeal shock wave therapy) as their next step
(70) rewrite
• 46 (55%) Some form of surgery with the most popular
operative interventions were gastrocnemius recession
(alone or in combination with another procedure) and
open partial plantar fascia release with nerve
decompression. (70)

65. • Time for the rational
argument based on their
research:
• Here are the common factors
which predispose a patient to
plantar fasciitis
•
• The risk of plantar fasciitis
increases as the range of ankle
dorsiflexion decreases.
• Obesity
• and work-related weight-
bearing
• pronation

66. HOW DOES THE FOOT ABSORB
IMPACTS
• The Arch Leaf Spring - There have been
studies on the arch with all muscles removed
leaving just the bones and ligaments. These
were extracted from cadavers. What the
study showed was that the arch complex
itself has the ability to spring back forces
without the aid of the muscles.
• The Spring Suspension System Muscles - I
coined these muscles as the spring
suspension system muscles, the landing
muscles or the pronation-supination cuff
muscles. I identified this new medical
terminology myself in order to better explain
the function of this area.
• The Windlass Mechanism - The plantar
fascia does not stretch much during push off,
so the arch of the foot must bend up to
accommodate the forces generated at push
off. This is like a spring from a bouncing ball.

67. First How The Body Absorbs The Stress Of Landing?
It absorbs Impacts two ways, rolling and loading…
• 1. Rolling the load from the outside of the foot
to the inside of the foot Supination (outside of
the foot) to Pronation (Inside of the foot)
• 2. It loads the force of the impact into the arch
of the foot

68. FORCES ON THE BODY
• Standing (50% of
bodyweight on each
foot)
• Walking (1.25 x
bodyweight on the foot at
landing)
• Running (3x bodyweight
on the foot at landing)
• Plyometrics (3-5x+
bodyweight on the foot at
landing)

69. Spring Suspension System Muscles
(Your Landing Gear)
• Tibialis Posterior AKA Posterior tibial tendon
dysfunction is the most common cause of
acquired flatfoot deformity in adults. he arch
is further supported by the plantar
aponeurosis, by the small muscles in the sole
of the foot, by the tendons of the Tibialis
anterior and posterior and Peronæus longus,
and by the ligaments of all the articulations
involved. Henry Gray (1821–1865). Anatomy
of the Human Body. 1918. rewrite
•
• The Peronæus longus also everts the sole of
the foot, and from the oblique direction of
the tendon across the sole of the foot is an
important agent in the maintenance of the
arch. Henry Gray (1825–1861). Anatomy of
the Human Body. 1918.

70. • Posterior tibial tendon
dysfunction is the most
common cause of acquired
flatfoot deformity in adults.
Although this term suggests
pathology involving only the
posterior tibial tendon, the
disorder includes a
spectrum of pathologic
changes involving
associated tendon,
ligament, and joint
structures of the ankle,
hindfoot, and midfoot

71. How does this Landing Gear Spring Suspension System fatigue
or weaken?
• Sudden gain in body
weight or obesity (50)
• Occupation involving
prolonged weight bearing
(50)
• Unaccustomed walking or
running (50)
• Increased running
distance or intensity (50)
• This just so happens to
be the same factors that
predispose you to
plantar fasciitis!
•
• How does this suspension
system breakdown or
weaken to allow the
excess weight not held by
the suspension system to
strain the plantar fascia?
•

72. What do I find (that other doctors don’t) when examining a
patient with plantar fasciitis.
• Over Pronation – Im Not The
Only One
• Weakness and tense painful
spasms In The Tibiailis
Posterior – Im Not The Only
One
• Locking Of The Metatarsal
Cuneiform Joint
• Thordarson et al found that
the posterior tibialis muscle
provided the most significant
dynamic arch support during
the stance phase of gait. The
posterior tibialis eccentrically
lengthens to control pronation
and reduce the tension
applied to the plantar fascia
during weight acceptance.
Excessive pronation can cause
posterior tibialis weakness and
plantar fascia elongation. (62)

73. most common factors that predispose
the patient to plantar fasciitis
• Sudden gain in body weight or
obesity (50)
• Occupation involving
prolonged weight bearing (50)
• Unaccustomed walking or
running (50)
• Increased running distance or
intensity (50)
• Changes in the walking or
running surface (50)
• Shoes with poor cushioning
(50)
• Tightness in the achilles
tendon (50)

74. • During the mid-
stance/pronation phase the
arch flattens to absorb the
shock of ground contact. Again
the elastic qualities of the
plantar fascia are tested. There
is a limit to how much
repetitive trauma this tissue
can sustain before micro tears
happen with pain usually
presenting on the calcaneus.
(49)
• IMPOSSIBLE THAT THE
PLANTAR FASCIA IS THE ONLY
STRUCTURE ABSORBING THE
FORCE OF THE LANDING

75. • These data indicate that
a history of plantar
fasciitis in runners may
be associated with
greater vertical ground
reaction force load rates
and a lower medial
longitudinal arch of the
foot. (54)

76. • The most frequent training
error seen with plantar fasciitis
is a rapid increase in volume
(miles or time run) or intensity
(pace and/or decreased
recovery). (49)
• A final training error seen in
athletics is with a rapid return
to some preconceived fitness
level. Remembering what one
did "last season" while
forgetting the necessity of
preparatory work is part of the
recipe for injury. (49)

77. • Training errors can be
responsible for up to
60% of injuries. (124)

78. • A change in shoes was
cited by 14 percent of
patients with plantar
fasciitis as the treatment
that worked best for
them. (73) Motion-
control and stability shoes
also have a firm heel
counter and a firm
midsole to control the
amount of pronation. (75)
•

79. The biggest mistake made in
stretching is:
• People don’t stretch the
foot
• When they stretch the foot
they don’t stretch the foot
in 3 dimensions
• They don’t stretch the foot
in the right direction
• They don’t stretch
individual bones of the foot
(metarsal cuneiform joints).
• They don’t stretch during
walking or running
• They don’t stretch enough

80. • This study provides
evidence that the
addition of TrP manual
therapies to a self-
stretching protocol
resulted in superior short-
term outcomes as
compared to a self-
stretching program alone
in the treatment of
patients with plantar heel
pain. (82) (83)

81. • Manual therapy
consisted of either
grade III or grade IV
joint mobilization
and/or high-velocity,
low-amplitude
chiropractic
manipulation to the
affected joints in the
foot and ankle, and
home-based exercise.

82. SPRING RESISTANCE TRAINING
• Exercises to Control
Excessive Pronation*
• Improved tibialis
posterior strength
• Improved plantar-flexor
strength
• Improved intrinsic foot
muscle strength
• Improved proximal hip
muscle strength

83. • Weakness can cause
increase force on the
plantar fascia
• The tendons of the
posterior tibialis, flexor
digitorum longus, flexor
hallucis longus, peroneus
longus, peroneus brevis,
and Achilles tendon were
attached to force
transducers. (65)