By professor Rosario Bellia - Professor of kinesiological taping ® at the State University of Valencia (Spain) - Physiotherapist of the Italian national FIHP
Plantar fasciitis and aponeurosis ruptures are diseases of the athlete's foot that can appear in sports that involve pushing or jumping, such as athletics, gymnastics and dance.
The plantar fascia - composed of three parts: external, internal, medium - plays an essential role in transmitting the forces of the triceps sural to the fingers, and its visco-elasticity allows for a large amount of energy to be restored for elastic stride with each stride or at every jump.
a) Plantar fasciitis: it is highlighted with pain in the sole of the foot, usually accentuated at the posterior and internal tuberosity, radiated along the inner margin of the aponeurosis both during movement and on palpation. Tensioning of the aponeursis, in the back flexion of the fingers and ankle, triggers the pain. The ultrasound shows irregularities in the zone of insertion of the fascia, and can show a "heel spur" which demonstrates the hyper-stress of the plantar fascia. Decompression bandage in the acute phase and use of visco-elastic plantar insoles; in the sporting return phase stability bandage.
b) rupture of the aponeurosis: it appears after a push effort (tripping, jumping) and results in a sharp, violent pain, accompanied by a sensation of tearing at the level of the sole of the foot and complete functional impotence; on palpation, pain is appreciated along the plantar fascia which prevails at the posterior tubercle, the preferred site of the rupture.
The plantar surface aponeurosis comprises an external part (1), an internal part (2) and an intermediate part (3), particularly affected by fasciitis, micro-breakage and breakage.
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The plantar aponeurosis, placed in series in the suroachyelecalar-plantar system, ensures a role of transmission of the triceps sural forces towards the fingers in running, running and jumping.
Etiopathogenesis of the lesion
Tendon and aponeurotic lesions, like the case of plantar fasciitis, can be classified, depending on their aetiology, in traumatic, microtraumatic and on a dysmetabolic and / or inflammatory basis.
The factors that can cause overdose pathologies in the tendons (and in many cases also in the muscles), of the foot and foot neck can be generically divided into intrinsic and extrinsic, and act in a variable percentage from subject to subject. As for the intrinsic factors, these are essentially:
a) anatomical variability, with consequent more or less marked alteration of the normal biomechanics of walking or athletic gesture, which subjects the foot and foot neck to abnormal stress;
b) dysmetabolic diseases, which can favor local phlogistic reactions, as well as provoke the alteration of the composition of the normal tendon tissue up to determine a more precocious aging;
c) the last factor, but no less important, is the age of the individual, the years of competitive activity and possible overweight-sportsmen. In fact, the aging of tendon tissue causes a metabolic slowing of tissue collagen, with a gradual decrease in the cell-matrix ratio in favor of the latter, a decrease in the water content of elastic fibers, proteoglycans and glycoproteins. The blue line also disappears, present at the junctional osteo-tendon level, which plays an important modulating and shock-absorbing action against mechanical stresses. As for the alteration of biomechanics, one of the main problems is the over-pronation of the foot and foot during running, which has a whipping action, like the bow of a bow, on the plantar aponeurosis, with consequent high frequency of inflammation.
As for the extrinsic factors, they often become decisive in the establishment of tendonopathy due to overload on the foot and foot neck. There are mainly three factors:
1) incongruous training
2) the competition or training grounds
3) the shoe
Plantar fasciitis: treatment »
