Materiały źródłowe

• #1 Plantar Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431073/

  Plantar fasciitis, a prevalent and often vexing condition, arises from the degenerative irritation of the plantar fascia origin at the medial calcaneal tuberosity of the heel and its surrounding perifascial structures. […] An absence of inflammatory cells characterizes this condition despite its name. […] While multifactorial in its origins, overuse stress is often the leading cause, presenting with sharp localized pain at the heel and, occasionally, a heel spur. […] Plantar fasciitis occurs due to degenerative irritation at the origin of the plantar fascia, located at the medial calcaneal tuberosity of the heel and the surrounding perifascial structures. […] The fascia is essential in supporting the arch and providing shock absorption. Despite featuring the -itis suffix in the diagnosis, this condition stands out for its absence of inflammatory cells.

• #2 Plantar fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Plantar_fasciitis

  Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. […] Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis. […] The cause of plantar fasciitis is poorly understood and appears to have several contributing factors. […] Plantar fasciitis is a non-inflammatory condition of the plantar fascia. […] Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. […] Repetitive microtrauma (small tears) appears to cause a structural breakdown of the plantar fascia. […] Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.

• #3 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. […] Studies have introduced the etiologic concept of fasciosis as the inciting pathology. Fasciosis, like tendinosis, is defined as a chronic degenerative condition that is characterized histologically by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. […] These changes suggest a noninflammatory condition and dysfunctional vasculature, which may be seen on ultrasound. […] With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.

• #4 Plantar Fasciitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p744.html

  Plantar fasciitis is a biomechanical overuse condition resulting in degenerative changes at its attachment to the calcaneus. Histologic examination of samples taken from patients undergoing plantar fascia release surgery shows myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. These findings support that the condition is a degenerative fasciosis without inflammation, not a fasciitis. Therefore, plantar fasciopathy is a more accurate descriptor. […] Plantar fasciitis (also called plantar fasciopathy, reflecting the absence of inflammation) is a common problem accounting for approximately 1 million patient visits per year, with about 60% of these to primary care physicians. It is the most common cause of heel pain in adults, with a lifetime incidence of about 10% and an increased incidence in women 40 to 60 years of age. Plantar fasciitis is associated with a variety of sports but is mostly reported in recreational and elite runners (incidence of 5% to 10%).

• #5 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyter.com/document/doi/10.7556/jaoa.2014.177/html?lang=en

  Plantar fasciitis is a chronic degenerative process involving the plantar aponeurosis of the foot, most commonly at its insertion into the medial tubercle of the calcaneus. The process involves repetitive strain that seems to cause microtearing, which induces a repair response. Histologic analysis demonstrates marked thickening and fibrosis of the plantar fascia along with collagen necrosis, chondroid metaplasia, and calcification. Although plantar fasciitis has historically been assumed to be primarily an inflammatory process, these findings suggest a principally degenerative mechanism, leading some authors to suggest that plantar fasciosis may be a more histologically accurate term. […] The plantar fascia is subject to chronic repetitive stress at its origin, and plantar fasciitis is one of the most common causes of heel pain. The diagnosis is often made clinically based on the location of pain at the medial calcaneal tubercle. Risk factors include age, female sex, obesity, prolonged weight bearing, and repetitive activities that cause strain on the plantar fascia. Imaging may be necessary to rule out other causes of heel pain in the differential diagnosis after nonsurgical treatment has failed or after the patient presents with atypical pain.

• #6 Plantar Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431073/

  The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress. […] Plantar fasciitis is often an overuse injury primarily due to a repetitive strain causing micro-tears of the plantar fascia. […] This condition is primarily a degenerative process. […] Histological findings include granulation tissue, micro-tears, collagen disarray, and a notable lack of traditional inflammation. […] Microtears occur due to the repetitive stress of standing upright and bearing weight, initiating the condition. […] The constant stretching of the plantar fascia results in chronic degeneration of the fascia, eventually leading to pain during sleep or at rest.

• #7 Plantar fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Plantar_fasciitis

  Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. […] Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis. […] The cause of plantar fasciitis is poorly understood and appears to have several contributing factors. […] Plantar fasciitis is a non-inflammatory condition of the plantar fascia. […] Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. […] Repetitive microtrauma (small tears) appears to cause a structural breakdown of the plantar fascia. […] Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.

• #8 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. […] Studies have introduced the etiologic concept of fasciosis as the inciting pathology. Fasciosis, like tendinosis, is defined as a chronic degenerative condition that is characterized histologically by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. […] These changes suggest a noninflammatory condition and dysfunctional vasculature, which may be seen on ultrasound. […] With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.

• #9 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. […] Studies have introduced the etiologic concept of fasciosis as the inciting pathology. Fasciosis, like tendinosis, is defined as a chronic degenerative condition that is characterized histologically by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. […] These changes suggest a noninflammatory condition and dysfunctional vasculature, which may be seen on ultrasound. […] With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.

• #10 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyter.com/document/doi/10.7556/jaoa.2014.177/html?lang=en

  Plantar fasciitis is a chronic degenerative process involving the plantar aponeurosis of the foot, most commonly at its insertion into the medial tubercle of the calcaneus. The process involves repetitive strain that seems to cause microtearing, which induces a repair response. Histologic analysis demonstrates marked thickening and fibrosis of the plantar fascia along with collagen necrosis, chondroid metaplasia, and calcification. Although plantar fasciitis has historically been assumed to be primarily an inflammatory process, these findings suggest a principally degenerative mechanism, leading some authors to suggest that plantar fasciosis may be a more histologically accurate term. […] The plantar fascia is subject to chronic repetitive stress at its origin, and plantar fasciitis is one of the most common causes of heel pain. The diagnosis is often made clinically based on the location of pain at the medial calcaneal tubercle. Risk factors include age, female sex, obesity, prolonged weight bearing, and repetitive activities that cause strain on the plantar fascia. Imaging may be necessary to rule out other causes of heel pain in the differential diagnosis after nonsurgical treatment has failed or after the patient presents with atypical pain.

• #11 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyter.com/document/doi/10.7556/jaoa.2014.177/html?lang=en

  Plantar fasciitis is a chronic degenerative process involving the plantar aponeurosis of the foot, most commonly at its insertion into the medial tubercle of the calcaneus. The process involves repetitive strain that seems to cause microtearing, which induces a repair response. Histologic analysis demonstrates marked thickening and fibrosis of the plantar fascia along with collagen necrosis, chondroid metaplasia, and calcification. Although plantar fasciitis has historically been assumed to be primarily an inflammatory process, these findings suggest a principally degenerative mechanism, leading some authors to suggest that plantar fasciosis may be a more histologically accurate term. […] The plantar fascia is subject to chronic repetitive stress at its origin, and plantar fasciitis is one of the most common causes of heel pain. The diagnosis is often made clinically based on the location of pain at the medial calcaneal tubercle. Risk factors include age, female sex, obesity, prolonged weight bearing, and repetitive activities that cause strain on the plantar fascia. Imaging may be necessary to rule out other causes of heel pain in the differential diagnosis after nonsurgical treatment has failed or after the patient presents with atypical pain.

• #12 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Traditionally, plantar fasciitis was considered an injury caused by overuse leading to repetitive microtrauma and damage to the plantar fascia. Although the term fasciitis has been attributed to the diagnosis of heel pain originating from the plantar fascia, it implies an inflammatory process, but it may be more appropriately termed plantar fasciosis. Histological findings include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, myxoid degeneration, and matrix calcification without leukocyte or macrophages, consistent with degenerative changes more so than an inflammatory process. […] Therefore, anti-inflammatory agents may be less useful, and treatment should instead target the root cause. Appreciating the chronic degenerative nature of this disorder leads one to reconsider currently common treatment methods such as corticosteroid injections.

• #13 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. […] Studies have introduced the etiologic concept of fasciosis as the inciting pathology. Fasciosis, like tendinosis, is defined as a chronic degenerative condition that is characterized histologically by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. […] These changes suggest a noninflammatory condition and dysfunctional vasculature, which may be seen on ultrasound. […] With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.

• #14 Plantar Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431073/

  The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress. […] Plantar fasciitis is often an overuse injury primarily due to a repetitive strain causing micro-tears of the plantar fascia. […] This condition is primarily a degenerative process. […] Histological findings include granulation tissue, micro-tears, collagen disarray, and a notable lack of traditional inflammation. […] Microtears occur due to the repetitive stress of standing upright and bearing weight, initiating the condition. […] The constant stretching of the plantar fascia results in chronic degeneration of the fascia, eventually leading to pain during sleep or at rest.

• #15 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  Biomechanical dysfunction of the foot is the most common etiology of plantar fasciitis; however, infectious, neoplastic, arthritic, neurologic, traumatic, and other systemic conditions can prove causative. The pathology is traditionally believed to be secondary to the development of microtrauma (microtears), with resulting damage at the calcaneal-fascial interface secondary to repetitive stressing of the arch with weight bearing. […] Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly with the first few steps after sleep or other periods of inactivity.

• #16

  https://journals.lww.com/jmut/fulltext/2023/31040/plantar_fasciitis__an_updated_review.2.aspx

  Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. […] PF was originally thought to be an acute inflammatory disease, but histologic findings of samples from patients undergoing surgery showed myxoid degeneration with fragmentation and degeneration of the plantar fascia, reflecting a chronic degenerative process without inflammation. […] Repetitive stress associated with standing upright and weight bearing may cause microtears in the plantar fascia, and the constant stretching of the fascia results in chronic degeneration, eventually leading to pain during sleep or at rest. […] In addition, vascular and metabolic disturbances, excessive free radicals, hyperthermia, and genetic factors have also been linked to degenerative change in connective tissues. […] Degenerative-atrophic changes of the heel fat pad were observed in patients with rheumatoid arthritis (RA) and spondyloarthropathies, which may also contribute to the chronic abnormalities of the plantar fascia.

• #17 Plantar Fasciitis | SpringerLink

  https://link.springer.com/10.1007/978-3-030-65430-6_259-1

  Plantar fasciitis is commonly referred to as an overuse injury caused by biomechanical dysfunctions and repetitive overload on the plantar fascia. […] Stress on the fascia leads to an acute inflammatory reaction, persistence of the mechanical stimulus over time leads to degenerative changes in the fascial tissue similar to those reported in chronic tendinopathies. […] The pathomechanics of plantar fasciitis.

• #18 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  A windlass is the tightening of a rope or cable. The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle. […] The previous discussion illustrates how the vertical and ground reaction forces stress the plantar fascia tissues. Integral to this discussion is the fact that plantar fascia pain results from excessive traction forces (increased tension) applied to the calcaneus. […] These results support the belief that pain occurs not from the bone spur but from the excessive tension applied to the plantar fascia. Excessive tension causes tissue irritation to the plantar fascia as well as to its origin at the medial calcaneal tubercle. […] In summary, the review of the literature provides evidence that plantar fasciitis results from increased plantar fascia tension; therefore, successful management depends on reversing the factors leading to excessive strain.

• #19 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #20 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #21 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #22 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  Biomechanical dysfunction of the foot is the most common etiology of plantar fasciitis; however, infectious, neoplastic, arthritic, neurologic, traumatic, and other systemic conditions can prove causative. The pathology is traditionally believed to be secondary to the development of microtrauma (microtears), with resulting damage at the calcaneal-fascial interface secondary to repetitive stressing of the arch with weight bearing. […] Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly with the first few steps after sleep or other periods of inactivity.

• #23 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Researchers have also reported faulty biomechanics and plantar fasciitis in subjects with a higher-arched foot. A higher-arched foot lacks the mobility needed to assist in absorbing ground reaction forces. Consequently, its inability to dissipate the forces from heel strike to midstance increases the load applied to the plantar fascia, much like a stretch on a bowstring. […] The windlass mechanism is a mechanical model that provides a thorough explanation of these biomechanical factors and stresses. The windlass mechanism describes the manner by which the plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on the plantar fascia. […] The plantar fascia prevents foot collapse by virtue of its anatomical orientation and tensile strength.

• #24 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Researchers have also reported faulty biomechanics and plantar fasciitis in subjects with a higher-arched foot. A higher-arched foot lacks the mobility needed to assist in absorbing ground reaction forces. Consequently, its inability to dissipate the forces from heel strike to midstance increases the load applied to the plantar fascia, much like a stretch on a bowstring. […] The windlass mechanism is a mechanical model that provides a thorough explanation of these biomechanical factors and stresses. The windlass mechanism describes the manner by which the plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on the plantar fascia. […] The plantar fascia prevents foot collapse by virtue of its anatomical orientation and tensile strength.

• #25 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  A windlass is the tightening of a rope or cable. The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle. […] The previous discussion illustrates how the vertical and ground reaction forces stress the plantar fascia tissues. Integral to this discussion is the fact that plantar fascia pain results from excessive traction forces (increased tension) applied to the calcaneus. […] These results support the belief that pain occurs not from the bone spur but from the excessive tension applied to the plantar fascia. Excessive tension causes tissue irritation to the plantar fascia as well as to its origin at the medial calcaneal tubercle. […] In summary, the review of the literature provides evidence that plantar fasciitis results from increased plantar fascia tension; therefore, successful management depends on reversing the factors leading to excessive strain.

• #26 Anatomy 101: The windlass mechanism & great toe extension — Rayner & Smale

  https://www.raynersmale.com/blog/2017/9/5/anatomy-101-the-windlass-mechanism-great-toe-extension

  The windlass mechanism refers to the function of the anatomy on the base of the foot, specifically the plantar aponeurosis, sesamoid bones, plantar pads and the attachment of these structures under the MTPJ. […] The outcome of these bones moving closer together in distance is a rising of the metatarsals forming the apex of the triangle and resulting in the MLA rising. […] When the foot reaches foot-flat or mid-stance, the tension in the plantar aponeurosis reduces and the foot is able to shock-absorb and adapt to the terrain through midfoot supination or pronation depending on the demand. […] Both of these behaviours were different to the normal pattern. At this time, nearly 20 years ago, these authors speculated that early onset of arch movement with first MTPJ extension would perhaps predispose the arch to higher tensile loads, while delayed onset of movement was more commonly seen in people with increased rear foot angle and more mid foot pronation. Both scenarios result in an ineffective windlass mechanism.

• #27 Anatomy 101: The windlass mechanism & great toe extension — Rayner & Smale

  https://www.raynersmale.com/blog/2017/9/5/anatomy-101-the-windlass-mechanism-great-toe-extension

  The windlass mechanism refers to the function of the anatomy on the base of the foot, specifically the plantar aponeurosis, sesamoid bones, plantar pads and the attachment of these structures under the MTPJ. […] The outcome of these bones moving closer together in distance is a rising of the metatarsals forming the apex of the triangle and resulting in the MLA rising. […] When the foot reaches foot-flat or mid-stance, the tension in the plantar aponeurosis reduces and the foot is able to shock-absorb and adapt to the terrain through midfoot supination or pronation depending on the demand. […] Both of these behaviours were different to the normal pattern. At this time, nearly 20 years ago, these authors speculated that early onset of arch movement with first MTPJ extension would perhaps predispose the arch to higher tensile loads, while delayed onset of movement was more commonly seen in people with increased rear foot angle and more mid foot pronation. Both scenarios result in an ineffective windlass mechanism.

• #28 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Several biomechanical abnormalities are common contributors to plantar heel pain and must be noted and addressed for adequate long-term resolution of this problem. Ankle joint equinus has been correlated with plantar fasciitis with an odds ratio of 23.3 for those with an ankle dorsiflexion less than 0 degrees. This lack of dorsiflexion at the ankle ultimately causes excessive subtalar pronation during gait as compensation, increasing the tensile load on the plantar fascia. […] Medial column stability is largely dependent on the tension created by the windlass mechanism and the plantar fascia; without this physiological tension the medial arch becomes unstable, allowing subtalar overpronation and increasing plantar heel pain. […] The kineticokinematic approach to plantar fasciitis guides treatment with a focus on decreasing plantar fascial strain via modification of the above-noted extrinsic and biomechanical factors.

• #29 Anatomy 101: The windlass mechanism & great toe extension — Rayner & Smale

  https://www.raynersmale.com/blog/2017/9/5/anatomy-101-the-windlass-mechanism-great-toe-extension

  The windlass mechanism refers to the function of the anatomy on the base of the foot, specifically the plantar aponeurosis, sesamoid bones, plantar pads and the attachment of these structures under the MTPJ. […] The outcome of these bones moving closer together in distance is a rising of the metatarsals forming the apex of the triangle and resulting in the MLA rising. […] When the foot reaches foot-flat or mid-stance, the tension in the plantar aponeurosis reduces and the foot is able to shock-absorb and adapt to the terrain through midfoot supination or pronation depending on the demand. […] Both of these behaviours were different to the normal pattern. At this time, nearly 20 years ago, these authors speculated that early onset of arch movement with first MTPJ extension would perhaps predispose the arch to higher tensile loads, while delayed onset of movement was more commonly seen in people with increased rear foot angle and more mid foot pronation. Both scenarios result in an ineffective windlass mechanism.

• #30 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Plantar fasciitis is an inflammation of the plantar fascia and the perifascial structures. Kwong et al classified it as a syndrome resulting from repeated trauma to the plantar fascia at its origin on the medial tubercle of the calcaneus. […] Historically, the literature attributes plantar fasciitis to faulty biomechanics such as excessive pronation. Structural deformities such as forefoot varus may result in excessive pronation during gait. Overpronation contributes to excessive foot mobility, which can increase the level of stresses applied to the musculofascial and soft tissue structures through plantar fascial elongation and increased tissue stress. […] Many studies have demonstrated that excessive foot motion is not deterministic of lower extremity problems. Cornwall stated that difficulties result when the joints of the foot are continually functioning beyond a normal end range. This can lead to greater stress along the medial joint capsules and ligamentous structures.

• #31 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Plantar fasciitis is an inflammation of the plantar fascia and the perifascial structures. Kwong et al classified it as a syndrome resulting from repeated trauma to the plantar fascia at its origin on the medial tubercle of the calcaneus. […] Historically, the literature attributes plantar fasciitis to faulty biomechanics such as excessive pronation. Structural deformities such as forefoot varus may result in excessive pronation during gait. Overpronation contributes to excessive foot mobility, which can increase the level of stresses applied to the musculofascial and soft tissue structures through plantar fascial elongation and increased tissue stress. […] Many studies have demonstrated that excessive foot motion is not deterministic of lower extremity problems. Cornwall stated that difficulties result when the joints of the foot are continually functioning beyond a normal end range. This can lead to greater stress along the medial joint capsules and ligamentous structures.

• #32 Treatment Pearls of Plantar Fasciitis

  http://www.aapsm.org/plantar_fasciitis.html

  Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome. Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock. Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners. In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot. […] Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis. Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain. Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations: when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).

• #33 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Researchers have also reported faulty biomechanics and plantar fasciitis in subjects with a higher-arched foot. A higher-arched foot lacks the mobility needed to assist in absorbing ground reaction forces. Consequently, its inability to dissipate the forces from heel strike to midstance increases the load applied to the plantar fascia, much like a stretch on a bowstring. […] The windlass mechanism is a mechanical model that provides a thorough explanation of these biomechanical factors and stresses. The windlass mechanism describes the manner by which the plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on the plantar fascia. […] The plantar fascia prevents foot collapse by virtue of its anatomical orientation and tensile strength.

• #34 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Researchers have also reported faulty biomechanics and plantar fasciitis in subjects with a higher-arched foot. A higher-arched foot lacks the mobility needed to assist in absorbing ground reaction forces. Consequently, its inability to dissipate the forces from heel strike to midstance increases the load applied to the plantar fascia, much like a stretch on a bowstring. […] The windlass mechanism is a mechanical model that provides a thorough explanation of these biomechanical factors and stresses. The windlass mechanism describes the manner by which the plantar fascia supports the foot during weight-bearing activities and provides information regarding the biomechanical stresses placed on the plantar fascia. […] The plantar fascia prevents foot collapse by virtue of its anatomical orientation and tensile strength.

• #35 Treatment Pearls of Plantar Fasciitis

  http://www.aapsm.org/plantar_fasciitis.html

  Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome. Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock. Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners. In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot. […] Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis. Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain. Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations: when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).

• #36 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Several biomechanical abnormalities are common contributors to plantar heel pain and must be noted and addressed for adequate long-term resolution of this problem. Ankle joint equinus has been correlated with plantar fasciitis with an odds ratio of 23.3 for those with an ankle dorsiflexion less than 0 degrees. This lack of dorsiflexion at the ankle ultimately causes excessive subtalar pronation during gait as compensation, increasing the tensile load on the plantar fascia. […] Medial column stability is largely dependent on the tension created by the windlass mechanism and the plantar fascia; without this physiological tension the medial arch becomes unstable, allowing subtalar overpronation and increasing plantar heel pain. […] The kineticokinematic approach to plantar fasciitis guides treatment with a focus on decreasing plantar fascial strain via modification of the above-noted extrinsic and biomechanical factors.

• #37 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Several biomechanical abnormalities are common contributors to plantar heel pain and must be noted and addressed for adequate long-term resolution of this problem. Ankle joint equinus has been correlated with plantar fasciitis with an odds ratio of 23.3 for those with an ankle dorsiflexion less than 0 degrees. This lack of dorsiflexion at the ankle ultimately causes excessive subtalar pronation during gait as compensation, increasing the tensile load on the plantar fascia. […] Medial column stability is largely dependent on the tension created by the windlass mechanism and the plantar fascia; without this physiological tension the medial arch becomes unstable, allowing subtalar overpronation and increasing plantar heel pain. […] The kineticokinematic approach to plantar fasciitis guides treatment with a focus on decreasing plantar fascial strain via modification of the above-noted extrinsic and biomechanical factors.

• #38 Understanding and Preventing Plantar Fasciitis Through Corrective Exercise

  https://blog.nasm.org/newletter/understanding-and-preventing-plantar-fasciitis-through-corrective-exercise

  Plantar fasciitis is the most common cause of heel pain, responsible for approximately 2 million orthopedic office visits annually and reported to affect between 10 and 20% of injured athletes. […] Plantar fasciitis can be characterized by pain in the heel when weight bearing and is generally worse in the morning when taking the first steps out of bed and with prolonged inactivity. […] The plantar fascia is influenced by several factors including arches that are too low resulting in too much motion or high arches resulting in too little motion. […] Any alteration in the mechanism will lead to compensation and breakdown of normal biomechanics. […] Prolonged weight bearing activities as noted above can cause posterior tibialis weakness and plantar fascia elongation. […] One potential cause of this may be related to a shortened Achilles tendon. This results in excessive pronation to compensate for the lack of motion, thus putting excessive stress on the plantar fascia.

• #39 What is plantar fasciitis and how is it treated? – Banff Sport Medicine

  https://banffsportmed.ca/plantar-fasciitis/

  Tight calf muscles inserting on the Achilles are a common reason for reduced dorsiflexion range of motion. […] This means that tight calf muscles directly put tension on the plantar fascia. […] The plantar fascia is able to adapt to the load placed on it, so slowly increasing training time and intensity when participating in high impact activities will decrease the risk of plantar fasciitis. […] There is moderate evidence supporting the use of orthotics or insoles for the treatment of plantar fasciitis. […] Treatments including shockwave, dry needling the calf muscles, injections, and taping also have moderate evidence supporting their use in the treatment on plantar fasciitis, but more research is needed to make conclusive decisions.

• #40 Understanding and Preventing Plantar Fasciitis Through Corrective Exercise

  https://blog.nasm.org/newletter/understanding-and-preventing-plantar-fasciitis-through-corrective-exercise

  Plantar fasciitis is the most common cause of heel pain, responsible for approximately 2 million orthopedic office visits annually and reported to affect between 10 and 20% of injured athletes. […] Plantar fasciitis can be characterized by pain in the heel when weight bearing and is generally worse in the morning when taking the first steps out of bed and with prolonged inactivity. […] The plantar fascia is influenced by several factors including arches that are too low resulting in too much motion or high arches resulting in too little motion. […] Any alteration in the mechanism will lead to compensation and breakdown of normal biomechanics. […] Prolonged weight bearing activities as noted above can cause posterior tibialis weakness and plantar fascia elongation. […] One potential cause of this may be related to a shortened Achilles tendon. This results in excessive pronation to compensate for the lack of motion, thus putting excessive stress on the plantar fascia.

• #41 What is plantar fasciitis and how is it treated? – Banff Sport Medicine

  https://banffsportmed.ca/plantar-fasciitis/

  Tight calf muscles inserting on the Achilles are a common reason for reduced dorsiflexion range of motion. […] This means that tight calf muscles directly put tension on the plantar fascia. […] The plantar fascia is able to adapt to the load placed on it, so slowly increasing training time and intensity when participating in high impact activities will decrease the risk of plantar fasciitis. […] There is moderate evidence supporting the use of orthotics or insoles for the treatment of plantar fasciitis. […] Treatments including shockwave, dry needling the calf muscles, injections, and taping also have moderate evidence supporting their use in the treatment on plantar fasciitis, but more research is needed to make conclusive decisions.

• #42 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Heel pain is one of the most common complaints treated by lower extremity specialists, affecting an estimated 10% of the population. […] Historically, treatment for plantar fasciitis has centered on the idea of supporting the plantar fascia by manipulating the foot into an ideal position to keep the medial arch from collapsing and preventing increased strain. However, most of the focus has been on the kinematics, or position, of the pedal architecture. Kinetic forces, or the forces that act on the foot, must also be considered in the treatment plan to improve symptoms. […] Plantar fasciitis is primarily a clinical diagnosis, which can be identified with a thorough history and physical examination. From the history, patients will report the hallmark post-static dyskinesia, or plantar heel pain after rest, which decreases after taking a few steps or spending more time on their feet. This phenomenon is believed to occur because of the lack of tension in a static non-weightbearing state; therefore the plantar fascia rests in a contracted state.

• #43 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles tendon increases the strain on the plantar fascia. This is called the windlass mechanism. […] As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. […] As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

• #44 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles tendon increases the strain on the plantar fascia. This is called the windlass mechanism. […] As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. […] As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

• #45 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles tendon increases the strain on the plantar fascia. This is called the windlass mechanism. […] As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. […] As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

• #46 Anatomy 101: The windlass mechanism & great toe extension — Rayner & Smale

  https://www.raynersmale.com/blog/2017/9/5/anatomy-101-the-windlass-mechanism-great-toe-extension

  Cheng et al (2008) were interested in further understanding the relationship between dorsiflexion angles, achilles tendon force and the impact on plantar fascia and the windlass mechanism to help direct treatment strategies that reduce plantar fascia strain in plantar fasciitis. […] They confirmed that when under load, the region of maximum stress of the plantar fascia is near the medial calcaneal tubercle (2008, p. 1942) which correlates with common clinical presentation of medial heel pain during weight bearing. […] But if walking occurs without great toe extension, not enough pressure is applied to the plantar aponeurosis to effectively raise the MLA which may place the foot in a biomechanically disadvantaged position with an ineffective windlass mechanism. Therefore, retraining plantar flexion with pressure through the great toe is important for normal biomechanics. […] The windlass mechanism aka movement of the medial longitudinal arch is essential for shock absorption and dissipation of forces through foot.

• #47 Plantar Fasciitis: Symptoms, Causes & Treatment Options

  https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis

  Plantar fasciitis is inflammation in the plantar fascia in your foot. Its the most common cause of heel pain. […] Plantar fasciitis happens when your plantar fascia is overused or stretched too far. Anything that damages your plantar fascia can make it swell. This inflammation makes it painful to walk or use your foot. […] Anything that irritates or damages your plantar fascia can cause plantar fasciitis, including: Being on your feet all day for work. Playing sports. Exercising or working on a hard surface (like a warehouse floor or the sidewalk). Exercising without stretching or warming up. Wearing shoes that dont support your feet well enough (like flip flops or flat, flexible sneakers). Walking or standing barefoot while youre at home. […] Some health conditions can cause plantar fasciitis, including: High arch feet. Flat feet. Obesity (or gaining more than 15 pounds in a few months).

• #48 Plantar Fasciitis: Symptoms, Causes & Treatment Options

  https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis

  Plantar fasciitis is inflammation in the plantar fascia in your foot. Its the most common cause of heel pain. […] Plantar fasciitis happens when your plantar fascia is overused or stretched too far. Anything that damages your plantar fascia can make it swell. This inflammation makes it painful to walk or use your foot. […] Anything that irritates or damages your plantar fascia can cause plantar fasciitis, including: Being on your feet all day for work. Playing sports. Exercising or working on a hard surface (like a warehouse floor or the sidewalk). Exercising without stretching or warming up. Wearing shoes that dont support your feet well enough (like flip flops or flat, flexible sneakers). Walking or standing barefoot while youre at home. […] Some health conditions can cause plantar fasciitis, including: High arch feet. Flat feet. Obesity (or gaining more than 15 pounds in a few months).

• #49 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Increased BMI, another known risk factor, also falls under the KK treatment approach for plantar fasciitis. In a recent study, patients with a mean BMI of 45 and a history of plantar fasciitis underwent bariatric surgery resulting in an average BMI of 34.8. Nearly 90% of the patients studied achieved complete resolution of plantar fasciitis and related symptoms, indicating weight loss may be a highly effective part of the treatment for plantar fasciitis. […] In conclusion, the kineticokinematic approach may be applied to successfully treat plantar fasciitis by addressing the positional (kinematic) and dynamic (kinetic) forces that cause stress on the plantar fascia.

• #50 Understanding and Preventing Plantar Fasciitis Through Corrective Exercise

  https://blog.nasm.org/newletter/understanding-and-preventing-plantar-fasciitis-through-corrective-exercise

  Several studies have suggested posterior muscle tightness could be involved in the etiology of plantar fasciitis. […] Adding SMR to the plantar fascia has also been suggested to enhance the flexibility of the posterior chain as reported by Grieve et al. […] In order to activate the weakened tibialis posterior muscle that occurs with prolonged weight bearing as noted above, an ankle inversion exercise using a resistance band is suggested. […] Proximal muscle weakness, including the gluteus medius, tensor fascia latae or quadriceps, can contribute to plantar fasciitis as well. This weakness can lead to poor shock absorption resulting in greater transmission of forces to the foot structures.

• #51 What Causes Plantar Fasciitis? – Squat University

  https://squatuniversity.com/what-causes-plantar-fasciitis/

  What he did find was dead or degrading tissue (called necrotic tissue). For years, the diagnosis of plantar fasciitis was given under the assumption it was driven by inflammation. Yet there was not any scientific evidence to support this claim! For this reason, Dr. Lemont recommended we stop incorrectly referring to this injury as plantar fasciitis and begin to refer to it as plantar fasciosis (as the osis ended refers to the degenerative process characterized by microtears and necrosis of plantar fascia). […] […] The answer comes down to a problem with blood flow. […] […] However, those who experience a loss of optimal blood flow to the bottom of the foot due to poorly fitting footwear are unable to optimally replenish and regenerate this tissue. Devoid of sufficient blood flow, the tissues on the inside of the heel that are supplied by the lateral plantar artery begins to degrade and symptoms of plantar fasciosis begin to set in. […] […] A large reason for this problem is the position of your big toe within narrow shoes! Consequently, this is the reason why bunions and plantar fascia pain are considered to be cousins (the greater the bunion deformity the increased risk of developing heel pain).

• #52 Reconsideration of the load-bearing functions of the plantar fascia and intrinsic foot muscles in the windlass mechanism | Scientific Reports

  https://www.nature.com/articles/s41598-025-97477-3

  Previous studies have indicated that the plantar fascia undergoes irreversible elongation only when subjected to a tensile force of 810 N and is considered a key structure that provides passive support to the MLA. […] The intrinsic foot muscles also play a role in maintaining the MLA under load, and their fatigue has been shown to cause a navicular drop during loading. […] Thus, the plantar fascia and intrinsic foot muscles are essential soft-tissue structures that support the windlass mechanism. […] The results of this study suggest that the windlass mechanism in the seated posture is primarily influenced by the plantar fascia and the flexor digitorum brevis, whereas in the single-leg standing posture, it is mainly influenced by the flexor digitorum brevis. […] This suggests that the role of the intrinsic foot muscles becomes significantly more pronounced under a load.

• #53 Reconsideration of the load-bearing functions of the plantar fascia and intrinsic foot muscles in the windlass mechanism | Scientific Reports

  https://www.nature.com/articles/s41598-025-97477-3

  This study aimed to explore the contributions of the plantar fascia and intrinsic foot muscles to medial longitudinal arch (MLA) support and the windlass mechanism under different toe extension angles in seated and single-leg standing postures. […] The plantar fascia and flexor digitorum brevis contributed to the windlass mechanism in the seated posture, while in the standing posture, the flexor digitorum brevis played a more pronounced role, with stiffness approximately six times greater than in the seated posture. […] These findings highlight the importance of intrinsic foot muscle training, such as towel curls, to improve MLA support and the windlass mechanism. […] The windlass mechanism refers to the phenomenon in which the height of the foot arch changes when the toes are extended.

• #54 Reconsideration of the load-bearing functions of the plantar fascia and intrinsic foot muscles in the windlass mechanism | Scientific Reports

  https://www.nature.com/articles/s41598-025-97477-3

  It has been suggested that the intrinsic foot muscles play a supporting role when excessive strain is applied to the plantar fascia, such as when bearing additional weight. […] By contrast, under a full load, such as in a standing posture, the windlass mechanism is predominantly driven by the flexor digitorum brevis. […] The results of this study suggest that soft tissues involved in the windlass mechanism may differ depending on the load conditions.

• #55 Reconsideration of the load-bearing functions of the plantar fascia and intrinsic foot muscles in the windlass mechanism | Scientific Reports

  https://www.nature.com/articles/s41598-025-97477-3

  It has been suggested that the intrinsic foot muscles play a supporting role when excessive strain is applied to the plantar fascia, such as when bearing additional weight. […] By contrast, under a full load, such as in a standing posture, the windlass mechanism is predominantly driven by the flexor digitorum brevis. […] The results of this study suggest that soft tissues involved in the windlass mechanism may differ depending on the load conditions.

• #56 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. […] Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. […] Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.

• #57 Plantar fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Plantar_fasciitis

  Disruptions in the plantar fascia’s normal mechanical movement during standing and walking (known as the Windlass mechanism) place excess strain on the calcaneal tuberosity and seem to contribute to the development of plantar fasciitis. […] Other studies have also suggested that plantar fasciitis is not due to the inflamed plantar fascia but maybe a tendon injury involving the flexor digitorum brevis muscle located immediately deep to the plantar fascia.

• #58 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. […] Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. […] Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.

• #59 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. […] Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. […] Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.

• #60 Plantar Fasciitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/plantar-fasciitis

  When a person suffers from plantar fasciitis, the bottom of the foot gets irritated and swells. […] Plantar fasciitis is a degenerative condition that results from repetitive stress that causes micro-tears in the fascia. If these tears occur frequently, the body loses its ability to heal itself, so a chronic state of inflammation ensues. […] Heel spurs are found in 50 percent of those with plantar fasciitis, although the mechanism with which they produce fascial damage is unclear. […] Mechanical support for the foot can be achieved through arch supports, heel cups, night splints and orthotics that can relieve pressure off the plantar fascia. […] In the most severe cases, surgery may be an option to release the pressure off the fascia.

• #61 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles tendon increases the strain on the plantar fascia. This is called the windlass mechanism. […] As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. […] As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

• #62 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles tendon increases the strain on the plantar fascia. This is called the windlass mechanism. […] As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. […] As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

• #63 Cause of Plantar Fasciitis | Pivotal Motion Physiotherapy

  https://pivotalmotion.physio/the-real-cause-of-plantar-fasciitis/

  The most common theory on how plantar fasciitis develops is that repeated strain on the fascia causes small tears to develop that eventually lead to pain. Excessive pronation (collapse of the arch) is often cited as the cause of increased mechanical loading of the fascia. […] Despite how frequently pronation is blamed, there is not much evidence that arch mechanics play a role in the condition. […] Tissue degeneration is more likely to occur in areas that receive a poor blood supply, or at locations in the connective tissue where the blood supply is cut off. […] Heel spurs were also once thought to be a feature of this condition, with the thinking that they were caused by the fascia pulling away from the bone. New evidence strongly suggests that spurs are unlikely to be a cause of fasciitis, and that they may develop due to compression rather than tensile force on the fascia.

• #64 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  A windlass is the tightening of a rope or cable. The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle. […] The previous discussion illustrates how the vertical and ground reaction forces stress the plantar fascia tissues. Integral to this discussion is the fact that plantar fascia pain results from excessive traction forces (increased tension) applied to the calcaneus. […] These results support the belief that pain occurs not from the bone spur but from the excessive tension applied to the plantar fascia. Excessive tension causes tissue irritation to the plantar fascia as well as to its origin at the medial calcaneal tubercle. […] In summary, the review of the literature provides evidence that plantar fasciitis results from increased plantar fascia tension; therefore, successful management depends on reversing the factors leading to excessive strain.

• #65 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #66 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #67 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #68 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #69 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #70

  https://journals.lww.com/jmut/fulltext/2023/31040/plantar_fasciitis__an_updated_review.2.aspx

  Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. […] PF was originally thought to be an acute inflammatory disease, but histologic findings of samples from patients undergoing surgery showed myxoid degeneration with fragmentation and degeneration of the plantar fascia, reflecting a chronic degenerative process without inflammation. […] Repetitive stress associated with standing upright and weight bearing may cause microtears in the plantar fascia, and the constant stretching of the fascia results in chronic degeneration, eventually leading to pain during sleep or at rest. […] In addition, vascular and metabolic disturbances, excessive free radicals, hyperthermia, and genetic factors have also been linked to degenerative change in connective tissues. […] Degenerative-atrophic changes of the heel fat pad were observed in patients with rheumatoid arthritis (RA) and spondyloarthropathies, which may also contribute to the chronic abnormalities of the plantar fascia.

• #71

  https://journals.lww.com/jmut/fulltext/2023/31040/plantar_fasciitis__an_updated_review.2.aspx

  Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. […] PF was originally thought to be an acute inflammatory disease, but histologic findings of samples from patients undergoing surgery showed myxoid degeneration with fragmentation and degeneration of the plantar fascia, reflecting a chronic degenerative process without inflammation. […] Repetitive stress associated with standing upright and weight bearing may cause microtears in the plantar fascia, and the constant stretching of the fascia results in chronic degeneration, eventually leading to pain during sleep or at rest. […] In addition, vascular and metabolic disturbances, excessive free radicals, hyperthermia, and genetic factors have also been linked to degenerative change in connective tissues. […] Degenerative-atrophic changes of the heel fat pad were observed in patients with rheumatoid arthritis (RA) and spondyloarthropathies, which may also contribute to the chronic abnormalities of the plantar fascia.

• #72 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

• #73 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

• #74 Effective Relief for Chronic Foot Pain: Focused Shockwave Therapy for Chronic Plantar Fasciitis – Central Ohio Spine and Joint

  https://cospineandjoint.com/focused-shockwave-therapy-chronic-plantar-fasciitis-relief/

  Focused shockwave therapy (FSWT) is a non-invasive treatment that has been gaining attention for its effectiveness in treating chronic plantar fasciitis, a common and often persistent kind of foot pain. […] FSWT is a form of extracorporeal shockwave therapy (ESWT). It uses high-energy acoustic waves concentrated on a small area. These waves travel through the skin and are focused on the affected area, providing a targeted approach that stimulates the body’s natural healing processes. […] Pain Reduction: FSWT helps reduce pain by over-stimulating nerves, thus reducing their sensitivity. […] Increased Blood Flow: The therapy promotes neovascularization, increasing blood flow to the area and enhancing tissue repair and regeneration. […] Stimulating Healing: The shockwaves stimulate the release of growth factors and the migration of stem cells, promoting tissue healing and regeneration.

• #75 Effective Relief for Chronic Foot Pain: Focused Shockwave Therapy for Chronic Plantar Fasciitis – Central Ohio Spine and Joint

  https://cospineandjoint.com/focused-shockwave-therapy-chronic-plantar-fasciitis-relief/

  Focused shockwave therapy (FSWT) is a non-invasive treatment that has been gaining attention for its effectiveness in treating chronic plantar fasciitis, a common and often persistent kind of foot pain. […] FSWT is a form of extracorporeal shockwave therapy (ESWT). It uses high-energy acoustic waves concentrated on a small area. These waves travel through the skin and are focused on the affected area, providing a targeted approach that stimulates the body’s natural healing processes. […] Pain Reduction: FSWT helps reduce pain by over-stimulating nerves, thus reducing their sensitivity. […] Increased Blood Flow: The therapy promotes neovascularization, increasing blood flow to the area and enhancing tissue repair and regeneration. […] Stimulating Healing: The shockwaves stimulate the release of growth factors and the migration of stem cells, promoting tissue healing and regeneration.

• #76 Physical therapy in Linwood for Heel Pain – Plantar Fasciitis

  https://www.parkinsonlifecenterofsouthernnj.org/Injuries-Conditions/Foot/Foot-Issues/Plantar-Fasciitis-Heel-Pain/a~259/article.html

  Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

• #77 Plantar fasciitis – important new research by Michael Rathleff – RunningPhysio

  https://www.running-physio.com/pf-new-research/

  One explanation could be that high-load strength training may stimulate increased collagen synthesis which help normalise tendon structure, increase load tolerability of the plantar fascia and thereby improve patient outcomes. Another explanation may be that the exercise help improve ankle dorsal flexion range of motion as well as improving intrinsic foot strength and ankle dorsal flexion strength. […] The loading paradigm for treatment of plantar fasciitis is by no means a miracle treatment. However, it does provide us with the first evidence that high-load strength training may be the road towards more effective treatments for plantar fasciitis.

• #78 Plantar fasciitis – important new research by Michael Rathleff – RunningPhysio

  https://www.running-physio.com/pf-new-research/

  One explanation could be that high-load strength training may stimulate increased collagen synthesis which help normalise tendon structure, increase load tolerability of the plantar fascia and thereby improve patient outcomes. Another explanation may be that the exercise help improve ankle dorsal flexion range of motion as well as improving intrinsic foot strength and ankle dorsal flexion strength. […] The loading paradigm for treatment of plantar fasciitis is by no means a miracle treatment. However, it does provide us with the first evidence that high-load strength training may be the road towards more effective treatments for plantar fasciitis.

• #79 Plantar fasciitis – important new research by Michael Rathleff – RunningPhysio

  https://www.running-physio.com/pf-new-research/

  Plantar fasciitis can be a nuisance to treat and, to date, we’ve had little high quality evidence to guide us. […] An interesting thing is that we are starting to realise that there are some similarities between plantar fasciitis and tendinopathy. We know from the literature that high-load strength training appears to be effective in the treatment of tendinopathy. A similar approach to plantar fasciitis therefore seems to be relevant to test. […] Our main question before initiating the trial was how we could induce high tensile forces across the plantar fascia to resemble the loads induced to the patella tendon during e.g. single leg squat. Our approach was to exploit the windlass mechanism during single-leg calf-raises by using a towel to dorsal flex the toes. In theory, the windlass-mechanism would cause a tightening of the plantar fascia during dorsal flexion of the metatarsophalangeal joints while high-loading of the Achilles tendon is transferred to the plantar fascia because of their close anatomical connection.

• #80 Plantar fasciitis – important new research by Michael Rathleff – RunningPhysio

  https://www.running-physio.com/pf-new-research/

  Plantar fasciitis can be a nuisance to treat and, to date, we’ve had little high quality evidence to guide us. […] An interesting thing is that we are starting to realise that there are some similarities between plantar fasciitis and tendinopathy. We know from the literature that high-load strength training appears to be effective in the treatment of tendinopathy. A similar approach to plantar fasciitis therefore seems to be relevant to test. […] Our main question before initiating the trial was how we could induce high tensile forces across the plantar fascia to resemble the loads induced to the patella tendon during e.g. single leg squat. Our approach was to exploit the windlass mechanism during single-leg calf-raises by using a towel to dorsal flex the toes. In theory, the windlass-mechanism would cause a tightening of the plantar fascia during dorsal flexion of the metatarsophalangeal joints while high-loading of the Achilles tendon is transferred to the plantar fascia because of their close anatomical connection.

• #81 Management of plantar fasciitis in the outpatient setting | SMJ

  http://www.smj.org.sg/article/management-plantar-fasciitis-outpatient-setting

  Heel spurs are now thought to be a result of traction forces on the plantar fascia origin rather than the cause of plantar fasciitis. […] The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat plantar fasciitis is a widespread practice that has been called into question, as plantar fasciitis is not an inflammatory process. This is supported by a recent study showing no significant difference in pain and disability scores in patients who were given NSAIDs compared to those who received a placebo. However, when combined with other treatment modalities, NSAIDs or simple analgesics may help to provide short-term pain relief. […] Localised steroid injections into the plantar fascia have been shown to provide effective short-term relief of plantar fascia pain for up to three months. There is, however, increased risk of plantar fat pad atrophy and plantar fascia rupture with repeated corticosteroid injections, and thus, repeated injections should be avoided if possible.

• #82 Management of plantar fasciitis in the outpatient setting | SMJ

  http://www.smj.org.sg/article/management-plantar-fasciitis-outpatient-setting

  Heel spurs are now thought to be a result of traction forces on the plantar fascia origin rather than the cause of plantar fasciitis. […] The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat plantar fasciitis is a widespread practice that has been called into question, as plantar fasciitis is not an inflammatory process. This is supported by a recent study showing no significant difference in pain and disability scores in patients who were given NSAIDs compared to those who received a placebo. However, when combined with other treatment modalities, NSAIDs or simple analgesics may help to provide short-term pain relief. […] Localised steroid injections into the plantar fascia have been shown to provide effective short-term relief of plantar fascia pain for up to three months. There is, however, increased risk of plantar fat pad atrophy and plantar fascia rupture with repeated corticosteroid injections, and thus, repeated injections should be avoided if possible.

• #83 Management of plantar fasciitis in the outpatient setting | SMJ

  http://www.smj.org.sg/article/management-plantar-fasciitis-outpatient-setting

  Heel spurs are now thought to be a result of traction forces on the plantar fascia origin rather than the cause of plantar fasciitis. […] The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat plantar fasciitis is a widespread practice that has been called into question, as plantar fasciitis is not an inflammatory process. This is supported by a recent study showing no significant difference in pain and disability scores in patients who were given NSAIDs compared to those who received a placebo. However, when combined with other treatment modalities, NSAIDs or simple analgesics may help to provide short-term pain relief. […] Localised steroid injections into the plantar fascia have been shown to provide effective short-term relief of plantar fascia pain for up to three months. There is, however, increased risk of plantar fat pad atrophy and plantar fascia rupture with repeated corticosteroid injections, and thus, repeated injections should be avoided if possible.

• #84 Plantar fasciitis: A New Approach to An Old Problem | Lower Extremity Review Magazine

  https://lermagazine.com/article/plantar-fasciitis-a-new-approach-to-an-old-problem

  Traditionally, plantar fasciitis was considered an injury caused by overuse leading to repetitive microtrauma and damage to the plantar fascia. Although the term fasciitis has been attributed to the diagnosis of heel pain originating from the plantar fascia, it implies an inflammatory process, but it may be more appropriately termed plantar fasciosis. Histological findings include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, myxoid degeneration, and matrix calcification without leukocyte or macrophages, consistent with degenerative changes more so than an inflammatory process. […] Therefore, anti-inflammatory agents may be less useful, and treatment should instead target the root cause. Appreciating the chronic degenerative nature of this disorder leads one to reconsider currently common treatment methods such as corticosteroid injections.

• #85 Plantar Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431073/

  The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress. […] Plantar fasciitis is often an overuse injury primarily due to a repetitive strain causing micro-tears of the plantar fascia. […] This condition is primarily a degenerative process. […] Histological findings include granulation tissue, micro-tears, collagen disarray, and a notable lack of traditional inflammation. […] Microtears occur due to the repetitive stress of standing upright and bearing weight, initiating the condition. […] The constant stretching of the plantar fascia results in chronic degeneration of the fascia, eventually leading to pain during sleep or at rest.

• #86 Plantar Fasciitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/86143-overview

  The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. […] Studies have introduced the etiologic concept of fasciosis as the inciting pathology. Fasciosis, like tendinosis, is defined as a chronic degenerative condition that is characterized histologically by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. […] These changes suggest a noninflammatory condition and dysfunctional vasculature, which may be seen on ultrasound. […] With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.

• #87 Plantar fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Plantar_fasciitis

  Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. […] Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis. […] The cause of plantar fasciitis is poorly understood and appears to have several contributing factors. […] Plantar fasciitis is a non-inflammatory condition of the plantar fascia. […] Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. […] Repetitive microtrauma (small tears) appears to cause a structural breakdown of the plantar fascia. […] Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.

• #88 Plantar fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Plantar_fasciitis

  Disruptions in the plantar fascia’s normal mechanical movement during standing and walking (known as the Windlass mechanism) place excess strain on the calcaneal tuberosity and seem to contribute to the development of plantar fasciitis. […] Other studies have also suggested that plantar fasciitis is not due to the inflamed plantar fascia but maybe a tendon injury involving the flexor digitorum brevis muscle located immediately deep to the plantar fascia.

• #89 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  Plantar fasciitis is an inflammation of the plantar fascia and the perifascial structures. Kwong et al classified it as a syndrome resulting from repeated trauma to the plantar fascia at its origin on the medial tubercle of the calcaneus. […] Historically, the literature attributes plantar fasciitis to faulty biomechanics such as excessive pronation. Structural deformities such as forefoot varus may result in excessive pronation during gait. Overpronation contributes to excessive foot mobility, which can increase the level of stresses applied to the musculofascial and soft tissue structures through plantar fascial elongation and increased tissue stress. […] Many studies have demonstrated that excessive foot motion is not deterministic of lower extremity problems. Cornwall stated that difficulties result when the joints of the foot are continually functioning beyond a normal end range. This can lead to greater stress along the medial joint capsules and ligamentous structures.

• #90 Reconsideration of the load-bearing functions of the plantar fascia and intrinsic foot muscles in the windlass mechanism | Scientific Reports

  https://www.nature.com/articles/s41598-025-97477-3

  Previous studies have indicated that the plantar fascia undergoes irreversible elongation only when subjected to a tensile force of 810 N and is considered a key structure that provides passive support to the MLA. […] The intrinsic foot muscles also play a role in maintaining the MLA under load, and their fatigue has been shown to cause a navicular drop during loading. […] Thus, the plantar fascia and intrinsic foot muscles are essential soft-tissue structures that support the windlass mechanism. […] The results of this study suggest that the windlass mechanism in the seated posture is primarily influenced by the plantar fascia and the flexor digitorum brevis, whereas in the single-leg standing posture, it is mainly influenced by the flexor digitorum brevis. […] This suggests that the role of the intrinsic foot muscles becomes significantly more pronounced under a load.

• #91 Detailed Explanation About the Pathophysiology of Plantar Fasciitis – Ankle, Foot and Orthotic Centre

  https://ankleandfootcentre.com.au/detailed-explanation-pathophysiology-plantar-fasciitis/

  Sometimes certain factors overload the Plantar Fascia. The body initially responds to overload with inflammation and cells called fibroblasts make new collagen in an attempt to bridge the gap caused by the injury. […] Continued walking and other influencing factors causes further stress, which limits the bodys ability to heal. As the condition progresses over weeks to months the inflammation diminishes and the collagen starts to unwind and unravel and then it breaks apart and becomes fragmented. […] At the same time the collagen is unwinding and breaking apart, fibroblasts are enlarging in an attempt to make more and more collagen. But, the unraveling outpaces the new collagen formation. […] Many new blood vessels are made quickly in an attempt to provide more blood flow to the area, but these vessels are abnormal and immature, and therefore are not very good at their job. The collagen that is created and added to the injured site is done so quickly and in a very disordered manner. […] The cell enlargement, poor blood flow, old collagen unraveling and disorganized new collagen all contribute to the thickening of the plantar fascia and pain.

• #92 Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC385265/

  A windlass is the tightening of a rope or cable. The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle. […] The previous discussion illustrates how the vertical and ground reaction forces stress the plantar fascia tissues. Integral to this discussion is the fact that plantar fascia pain results from excessive traction forces (increased tension) applied to the calcaneus. […] These results support the belief that pain occurs not from the bone spur but from the excessive tension applied to the plantar fascia. Excessive tension causes tissue irritation to the plantar fascia as well as to its origin at the medial calcaneal tubercle. […] In summary, the review of the literature provides evidence that plantar fasciitis results from increased plantar fascia tension; therefore, successful management depends on reversing the factors leading to excessive strain.

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