The Inverted Pendulum, Spring Mass and Integrated Spring Mass Approach to Treating Plantar Fasciitis

• 1. Plantar FasciitisPlantar Fasciitis is the most commoncause of heel pain in adults.Plantar FasciitisTop 10 most commonconditions of the lower body1. Patellofemoral Pain Syndrome2. Iliotibial Band FrictionSyndrome3. Plantar Fasciitis4. Meniscal Injuries Of The Knee5. Tibial Stress Syndrome6. Patellar Tendonitis7. Achilles Tendonitis8. Gluteus Medius Injuries9. Stress Fracture Tibia10. Spinal Injuries

2. Plantar Fasciitis AKA Plantar fasciitis is often called heel spurs, althoughthis terminology is somewhat of a misnomer because15 to 25 percent of the general population withoutsymptoms have heel spurs and many symptomaticindividuals do not. (9) The other names for plantar fasciitis are plantarfascitis, plantar fasciosis, fasciitis plantaris, plantarfascial fibromatosis, plantar heel pain syndrome,policeman's heel, heel spur syndrome, painful heelsyndrome, and inferior calcaneal exostoses. 3. Relationship to Heel SpursAround 50 percent ofpatients with plantarfasciitis have heel spurs,but they are most oftenan incidental finding anddo not correlate well withthe patient's symptoms. (8) 4. What is Plantar Fasciitis? It is by definition, a painful inflammation ofthe plantar fascia. It is an abnormality or injury at the site ofattachment of a ligament or tendon to bone)of the origin of the plantar fascia at the medialtubercle of the calcaneus due to excesstraction often characterized by pain on thefirst step in the morning (2) or when theystand up after prolonged sitting. (1) 5. Incidence Plantar fasciitis is the most common cause ofheel pain with ten percent of the populationwill pull up with plantar fasciitis in theirlifetime. (5) The condition accounts for eleven to fifteenpercent of all foot symptoms, affecting twomillion people in the United States alone. (4) 6. What are the symptoms ofplantar fasciitis? The tenderness you would feel is usually noted on the medialcalcaneal tuberosity (see image) and along the plantar fascia. Theclassic sign or plantar fasciitis is pain on first few steps in themorning. The pain usually decreases after you walk it off, but canreturn throughout the day the longer you are on your feet. Most feel the symptoms of pain when standing on feet too long.The pain can come on worse at the end of the day. Its morecommon and more severe in those who are overweight, obese orweakness in specific muscles of the foot. The pain often increases with stretching of the plantar fascia, whichis achieved by lifting your foot (dorsiflexion) and toes up. (8) 7. Causal Connection to Heel Spurs Fuller stated that fascial stretching caused pain either to the plantarfascia itself or at the attachment to the bone. High tension in thefascia could also cause a periosteal lifting at its insertion on thecalcaneus, and bone healing could cause growth of a spur thatmight be seen at the calcaneus. (61) Plantar fasciitis is generally believed to be due to repetitive partialtearing at this enthesis with associated chronic inflammation. (2) These results support the belief that pain occurs not from the bonespur but from the excessive tension applied to the plantar fascia (11) 8. Doesnt Plantar FasciitisOnly Effect Athletes? No! Plantar fasciitis is usually seen as an overuse injury in athletes, runners inparticular (accounting for nearly 10% of running injuries), but is also seen in nonathletes too. (3) Most non-athletes have it in the subclinical state, which means that there isinflammation of the fascia but not enough to cause pain you can feel unless youpress into the fascia called deep tissue palpation. If non-athletes have this form of non painful inflammation of the fascia and walk afew blocks barefoot or run with or without shoes they will feel the pain in theirfascia as the inflammation rises to a point where the nerves and brain togethersense the higher concentration of inflammation. I check the plantar fascia and the health of the feet for all conditions because I feelthe status of the foundation of our body or the bodies spring suspension system 9. What Causes Plantar Fasciitis? Plantar fasciitis is one of the more common soft-tissuedisorders of the foot, yet little is known about itsetiology. The fascia foot pain is caused by stress and strain in thearea, that leads to the release of inflammation andwhen the inflammation gets high enough you feel pain. Although the pathology of plantar fasciitis isunderstood the development or causes of plantarfasciitis is less agreed upon. 10. What Causes Plantar Fasciitis? Also, although plantar fasciitisis a prevalent problem, littlescientific evidence existsconcerning the mostappropriate treatmentapproach or intervention. (3) Why? Because doctors cannot agreeon the cause of plantar fasciitisit makes it difficult forphysicians to diagnose andtreat this common injury. I explain why in thispresentation 11. Three Schools Of Bio-Mechanics Inverted Pendulum Model and The LeverSeries Model (1685) The Spring- Mass Model (1989/1990) The Integrated Spring-Mass Model (2012) 12. Plantar FasciitisExamination, Treatment and PreventionInverted Pendulum/Lever Series ApproachvsIntegrated Spring-Mass ApproachHow do they differ? 13. What is the plantar fascia? The plantar fascia, also known as the plantar aponeurosis is a broad, flat, fibrous,tendon-like structure, which consists of non-contractile irregularly ordered collagenfibers with minimal elastic properties. (13)What does that mean? What that means is that it is like gristle on a steak. It means it doesnt stretch much. It means it does not contract like a muscle.What roll does it play? The plantar aponeurosis plays an important role in transmitting Achilles tendonpull forces to the forefoot when you are about to push off when you walk. (46) 14. Inverted Pendulum/Lever Series Approach Many lever model only thinkers believe we ambulatewith levers in linkages. That is why they are validated when they note thesymptom of pain in the fascia when we have tension on theAchilles tendon through the gastroc/soleus musclecontraction. (2) Unfortunately, Pendulum-Lever model only thinkers cantprovide much of an explanation for how the mechanismbreaks down to cause the stress on the plantar fascia. They have few theories 15. This is what the lever model thinkerssay causes plantar fasciitis Increasing tension on the Achillestendon is coupled with anincreasing strain on the plantarfascia. Overstretching of theAchilles tendon resulting fromintense muscle contraction andpassive stretching of tight Achillestendon are plausible mechanicalfactors for overstraining of theplantar fascia. (24) What is causing theoverstretching or strain on theAchilles and fascia is the magicquestion to solving this riddle 16. Inverted Pendulum/Lever Series Approach the human lever model says that the primaryreason for why the fascia has stress is becauseof a tight fascia due to a tight Achilles. I have never found the Achilles tight in one ofthe patients I have examined with plantarfascia in my life. 17. Why Tight Achilles isNot a Cause of Plantar Fasciitis1. The Achilles is not a contractile element1. The plantar fascia has no contractileelements.2. There is no research that shows increasedelectrical activity in the Achilles muscle groupcoincides with plantar fasciitis (no proof) 18. Lever Series saysTight Achilles is the Cause? For example: the human levermodel says that the primaryreason for why the fascia hasstress is because of a tightfascia due to a tight Achilles. I have never found the Achillestight in one of the patients Ihave examined with plantarfascia in my life. No biomechanical explanationwhy Achilles Tendon Musclegroup is Tight or in Spasm inthe Scientific Literature. 19. Achilles SpringThe gastrocnemius and soleus do not push the body forward when walking or running They spring itforward An average of 38 J of energy was recovered from the elastic recoil of the tendon, which contributes16% of the total average mechanical work of the hop (254 J). (65) In conclusion, the properties of the elastic Achilles tendon can contribute significantly to the totalmechanical work of the body during one-legged hopping; however, individual variation in theproperties of the tendon vary the energy storing capacity of this structure. (65) The results indicated that the AT does indeed act like an energy storing spring by contributing aconsiderable amount of energy to the total mechanical work performed. (65) The results of this study demonstrated the energy storing capabilities of the AT, whereby thetendon stretches in proportion to the force applied during the downward motion of the body andthen recoils to release most of the energy stored (74%) during the upward movement. Thisprovides a substantial amount of the total mechanical energy of the hop (16%). (65) 20. If Spasms or Tight Achilles then.. If the cause of plantar fasciitis is spasms or tightness in the AchillesTendon Group then how does this relate to the normal cause whichis standing on the feet too long? If the cause of plantar fasciitis is spasms or tightness in the AchillesTendon Group then you should find trigger points or muscle spasmsin the area. If tension in the Achilles then the plantar fascia would still pull onlyharder and the windlass mechanism would still work because thefascia is connective tissue and not muscle. It doesnt make sense! 21. Primary Cause Standing on yourfeet too long 22. The Effect Of Flip-flops On Dorsiflexionand Tibialis Anterior Electromyography. The study also showed that female subjects had amore vertical attack angle in flip-flops whencompared to athletic sneakers Specifically, as the non-support leg swings through,the tibialis anterior (TA) demonstrated an increasein muscle activity, yet less dorsiflexion (DF) wasnoted compared to barefoot walking. This finding was counterintuitive, as the TA is aprimary dorsiflexor, and more activity should havebeen realized with an increase in dorsiflexion. the counterintuitive finding of increased dorsiflexormuscular activity and less observed dorsiflexionangle leads the author to conclude that theincreased activity of the TA in the presence of lessdorsiflexion could be the result of the flip-flopwearers attempt to grip the flip-flop using theplantar surface of the foot. Reciprocal inhibition, Internal Compressive Forces -Bang and Twist Plantar Fasciitis and Shin Splints 23. More Evidence of Spring vs Push This study we investigated in vivo length changes in thefascicles and tendon of the human gastrocnemiusmedialis (GM) muscle during walking.Two important features emerged: the muscle contracted near-isometrically in the stancephase, with the fascicles operating at ca. 50 mm; and the tendon stretched by ca. 7 mm during single support,and recoiled in push-off.The spring-like behavior of the tendon indicates storage andrelease of elastic-strain energy 24. Basis of Lever Model Treatment There is an indirect relationship whereby if the toesare dorsiflexed, the plantar fascia tightens via thewindlass mechanism. If a tensile force is thengenerated in the Achilles tendon it will increasetensile strain in the plantar fascia. Clinically, thisrelationship has been used as a basis for treatmentfor plantar fasciitis, with stretches and night stretchsplinting being applied to the gastrocnemius/soleusmuscle unit. (18) 25. Cause: Preloading by Dorsiflexors The results show that the PA experiencedtension significantly above rest during earlystance phase in all subjects (P