ArticlePDF Available

Plantar Fasciitis and Its Relationship with Hallux Limitus

Authors:

Abstract and Figures

Background: We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. Methods: The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. Results: In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). Conclusions: Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.
Content may be subject to copyright.
A preview of the PDF is not available
... This can be explained by the difficulty in measuring the foot pronation of the runner in the 2D frontal analysis, so the literature suggests other indirect variables for the analysis, such as heel eversion [17]. On the other hand, supinated foot, which is characterized by the presence of stiffness in the medial longitudinal arch with calcaneal inversion and varus hindfoot [18], is related in the literature with plantar fasciitis and ankle injuries [19]. In the present study, there is a 33% relationship between runners with supinated foot and those affected with posterior tibial injury. ...
Article
Full-text available
To correlate the most prevalent ankle and foot injuries in amateur runners with the biomechanical analysis of running, considering the patterns of frontal analysis evaluated in a private orthopedic and physical therapy service. Retrospective analysis of 56 medical records of amateur runners with ankle and foot complaints who underwent biomechanical assessment of running in an Orthopedics and Physical Therapy clinic in 2017 and 2018. Lesions found: Shin splints (26.78%); plantar fasciitis (21.42%); Achilles tendinopathy (21.42%); Tibial Stress Syndrome (8.92%); lower limb stress fractures (5.35%); posterior tibial tendonitis (5.35%); peroneal tendinopathy and ankle sprain (7.14%); talar chondral lesion (1.78%) and Morton’s neuroma (1.78%). The biomechanical analysis showed that the most common findings were valgus knees, with 43 cases (76.78%), followed by pelvic drop and center of mass vertical oscillation, with 40 cases each (71.42%) and hamstring retraction, with 37 cases (66.07%). Among the least prevalent, varus knees and supinated foot stand out, with two cases each (3.57%) and medial or lateral heel whip (5.35%, 3 cases). The most prevalent findings were valgus knee, pelvic drop, center of mass vertical oscillation, and hamstring retraction. Among the least present, stand out the varus knees, the supinated foot and the medial or lateral heel whip.
... With respect to the descriptive data collected, passive first metatarsophalangeal joint extension ROM was decreased in the runners with PHP. This result was consistent with a study by Aranda and Munuera [31], and may be an adaptation to avoid the pain commonly associated with near end-range first metatarsal phalangeal joint extension. ...
Article
Background: Plantar heel pain associated with plantar fascia pathology (PHP) is one of the most common running overuse injuries. Degeneration and changes in the mechanical properties of the plantar fascia associated with PHP can result in changes in foot kinematics during gait. Research question: How do running gait foot kinematics differ between female and male runners with and without PHP? Methods: Retrospective study of 13 runners with PHP (7 female, 6 male) and a matched group of 13 uninjured runners (6 female, 7 male). A seven-segment foot model was used to quantify six functional articulations (rearfoot complex, lateral and medial midfoot, lateral and medial forefoot, and first metatarsophalangeal). Functional articulation ROM during early, mid, and propulsion running stance subphases was assessed. Two-way ANOVAs and Friedman's two-way ANOVA for ranks tests were conducted for normally distributed variables and non-normally distributed variables, respectively. Results: During early stance, PHP runners demonstrated significantly increased lateral midfoot eversion ROM compared to uninjured runners. During the propulsion phase, male runners with PHP demonstrated increased medial midfoot eversion and dorsiflexion ROM and increased medial forefoot plantar flexion compared to uninjured male runners. Also during propulsion, females with PHP went through significantly less medial forefoot plantar flexion ROM compared to uninjured female runners. Significance: Given the function of the plantar fascia to assist foot supination, the differences in runners with PHP, which were consistent with increased pronation or inadequate supination, may be the result of insufficient tension during the stance phase of running gait caused by degeneration of the plantar fascia. Further, the significant medial midfoot and medial forefoot group by sex interactions during propulsion suggest that PHP may affect male and female runners differently. Understanding the effect of PHP on foot function during running may aid in the development of future rehabilitation programs and/or treatment outcome assessments.
... The correlation between ROM of 1st MPJ and COP agrees with the results of another study that found that a loss of ROM at the 1st MPJ can cause an increase of the area COP due to a poorer mechanism of control [18]. Another study found a link between plantar fasciitis and limited ROM at the 1st MPJ which caused increased tension to the plantar fascia [46] and the higher the tension on the plantar fascia, the lower the stability of the longitudinal arch of the foot. So, this correlation can explain why patients with plantar fasciitis have poorer balance. ...
Article
Purpose To assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions. Methods Thirty participants (n =15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants. Results Clinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests. Conclusions Individuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.
... Secondary outcomes included: the number of patients that reached a minimal important improvement in their total FFI score (an improvement of at least 6.5), the number of patients that considered themselves recovered, the first step pain according to a 11 point NRS and the number of patients that reached a minimal important improvement in their first step pain (an improvement of at least 1.9.) [26,27] Potential prognostic variables were selected based on supposed clinical relevance and existing literature. The following variables were considered: age, sex, BMI, upper ankle dorsiflexion range of motion in the affected foot, MTP1 dorsiflexion range of motion in the affected foot, navicular drop (ND) in the affected foot, neuropathic pain score in the affected foot (DN4), having bilateral pain, degree of physical activity, reporting other illnesses in the last 12 months, duration of symptoms, FFI scores at baseline and the FPI [22,25,[28][29][30]. The FPI was divided into three groups. ...
Article
Full-text available
Background Plantar heel pain (PHP) is a common cause of foot complaints, for which treatment with custom-made insoles is frequently applied. So far few studies have investigated patient characteristics that predict response to these treatments. The aim of this secondary exploratory analysis was twofold; firstly, to identify patient characteristics that predict prognosis in patients with PHP treated with insoles, and secondly to identify characteristics that might interact with treatment with insoles. Methods Data from a randomized trial in which participants received either custom insoles ( N = 70) or sham insoles ( N = 69) were used. At baseline, information was collected on demographics, foot symptoms, foot and ankle range of motion, navicular drop, presence of neuropathic pain, physical activity and other illnesses in the last 12 months. The primary outcome of this study was the Foot Function Index score (FFI) at 26 weeks. Multivariable linear regression models were generated to identify patients characteristics that predict the outcome for each type of intervention (i.e. insoles and GP-led usual care). Results We found two variables associated with a better function score at 26 weeks in patients treated with insoles, female sex (β − 9.59 95%CI -17.87; − 1.31) and a lower FFI score at baseline (β 0.56 95%CI 0.30; 0.82). Explorative analyses in patients treated with insoles showed no significant interaction effects between the type of insole (custom-made versus sham) and any of the potential predictive factors. Conclusion When communicating about the effect of insoles for PHP clinicians should take sex and the amount of pain and disability at first presentation into account. Women and people with better foot function scores at baseline (according to FFI) might respond better to treatment with insoles in terms of foot function. Trial registration Trial registration: NTR5346 .
... On the other hand, Aranda et al mention that the participants with plantar fasciitis presented less extension of the hallux, however it cannot be established that the limitation of this range of motion is a cause or effect of plantar fasciitis, in addition to the relationship of the alignment of the plantar fasciitis. foot, in this case pronated or supinated (32). In this regard, Frimenko et al developed a relationship curve between the mobility of the hallux and the risk of injury to the phalangeal metatarsal joint, pointing out that at 78° of extension there is a 50% probability of injuring the joint; however, related aspects of AMA are not described based on the prediction of the risk of injury (33). ...
Article
Full-text available
Introduction: Dynamic balance (DB) is the basis for all sports motor activities. Variables such as the type of foot and the windlass mechanism (WM) could influence this balance and therefore the risk of injury to the lower limb. Currently no studies are reported that relate these elements to each other in soccer players. Objective: To determine the influence of some characteristics of the foot on the risk of injury associated with DB in young soccer players. Methods: Observational, cross-sectional, and correlational study. Forty players were included in the male sub 20 category. DB was evaluated by means of the Y balance test (YBT). To determine the type of the foot, the Herzco method and Jack's test were used to evaluate the WM. Results: Statistically significant differences were found between the type of the foot and the Jack test with some scopes of the YBT. There was a significant relationship between the left WM vs left DB. Conclusion: Foot’s type and the WM influence the DB. The WM could be related to the DB, however, there seems to be no relationship between Hallux’s evaluation and foot type with the DB. Variables such as the quality of execution of the sporting gesture, exposure to load, among others, should be considered when studing the issue.
... They also found the PHP group had a more pronated foot compared with the control group (mean FPI 6.5 versus 3.5, P < 0.020, which we calculate to be a large effect size). However, there are marked differences between the sample recruited by Hogan et al. and that in our study, and the studies mentioned above [18][19][20] . The mean age in the Hogan et al. study was approximately 26 years, while in our study and the other studies it was substantially older, ranging from 48 to 55 years. ...
Article
Full-text available
Foot posture and ankle joint dorsiflexion have long been proposed to be risk factors for plantar heel pain, however body mass may be a confounder when investigating these factors. The aim of this study was to determine if clinical measures of foot posture and ankle joint dorsiflexion differ in adults with and without plantar heel pain after accounting for body mass. This was a cross-sectional observational study that compared 50 participants with plantar heel pain to 25 control participants without plantar heel pain who were matched for age, sex and body mass index. Foot posture was assessed using the Foot Posture Index and the Arch Index. Ankle joint dorsiflexion was assessed with a weightbearing lunge test with the knee extended and with the knee flexed. No significant differences (P < 0.05) were found between the groups for foot posture, whether measured with the Foot Posture Index or the Arch Index. Similarly, no significant differences were found in the weightbearing lunge test whether measured with the knee extended or with the knee flexed. Clinical measures of foot posture and ankle joint dorsiflexion do not differ in adults with and without plantar heel pain when body mass is accounted for. Therefore, clinicians should not focus exclusively on foot posture and ankle dorsiflexion and ignore the contribution of overweight or obesity.
... 22 Exercises to increase the range of motion in the first metatarsal and ankle joints were recommended. [23][24][25] Participants were given a leaflet with the information to remind them what must be done at home. The number of participants included in this study was determined based on a visual analogue scale and algometry. ...
Article
Full-text available
Objectives To evaluate and compare the efficacy of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) for plantar fasciitis. Design A participant blind randomized controlled trial with parallel group design and an active comparator with follow-up at four weeks. Settings Outpatient, University hospital. Subjects Unilateral plantar fasciitis participants (n = 102) were randomly assigned into two groups. Recruitment period was from January 2017 to April 2019. Interventions Interventions included eight sessions of laser therapy over three weeks and single session of patient education. The HILT group (n = 51) received HILT and the LLLT group (n = 51) received LLLT. Main measures Primary outcomes: visual analogue scale; secondary outcomes: pressure algometry, sonography of plantar fascia thickness (time frame: baseline to three-week and four-week follow-up) and numeric rating scale (0%–100%) for opinion of participants on effect of treatment (time frame: three weeks). Data presented: mean (SD) or n (%). Results There was no statistically significant difference between the groups according to visual analogue scale (pain in general reduction in three weeks: 2.57(3.45) vs. 2.88(3.28) cm), pressure algometry (pain threshold difference between healthy and affected heel reduction in three weeks: 1.80(6.39) vs. 1.77(2.85) kg) and sonography measurements (plantar fascia thickness difference between healthy and affected heel reduction in three weeks: 0.19(0.56) vs. 0.30(0.57) mm). There was a statistically significant difference between the groups in participants’ opinion in favor to HILT group (efficacy of treatment better than 50%: 26(51%) vs. 37(73%)). Conclusion No statistically significant difference between groups was observed.
Article
Objective. To evaluate the effect of minimally invasive ultrasound-guided fascial release and a foot orthoses with first metatarsal head cut-out on the biomechanics of the medial longitudinal arch of the foot in cadaveric specimens. Design. A cross-sectional study was designed (20 body-donors). Anthropometric measurements of the foot, foot posture index and the windlass test and force were measured in different conditions: unloaded, loaded position, with foot orthoses, after a 25% plantar fascia release and after a 50% release. Results. For the anthropometric measurements of the foot, differences were found in foot length (p=0.009), arch height (p<0.001) and midfoot width (p=0.019) when comparing the unloaded vs foot orthoses condition. When foot orthoses were compared with 25% plantar fascial release, differences were found in foot length (p=0.014) and arch height (p<0.001). In the comparation with 50% plantar fascial release, differences were found in the arch height (p<0.001). A significant interaction between foot orthoses condition and grades was found in the arch height during the windlass test (p=0.021). Conclusion. The results indicate that the presence of foot orthoses leads to a significant increase in arch height compared to other conditions. Furthermore, when plantar fascia release is performed, the arch does not exhibit any signs of collapse.
Article
Background: Plantar first metatarsal ulcerations pose a difficult challenge to clinicians. Etiologies vary and include first metatarsal declination, cavus foot deformity, equinus contracture, and hallux limitus/rigidus. Our pragmatic, sequential approach to the multiple contributing etiologies of increased plantar pressure sub–first metatarsal can be addressed through minimal skin incisions. Methods: A retrospective review was performed for patients with surgically treated preulcerations or ulcerations sub–first metatarsal head. All of the patients underwent a dorsiflexory wedge osteotomy, and the need for each additional procedure was independently assessed. Equinus contracture was treated with Achilles tendon lengthening, cavovarus deformity was mitigated with Steindler stripping, and plantarflexed first ray was treated with dorsiflexory wedge osteotomy. Results: Eight patients underwent our pragmatic, sequential approach for increased plantar pressure sub–first metatarsal, four with preoperative ulcerations and four with preoperative hyperkeratotic preulcerative lesions. The preoperative ulcerations were present for an average of 25.43 weeks (range, 6.00–72.86 weeks), with an average size of 0.19 cm ³ (median, 0.04 cm ³ ). Procedure breakdown was as follows: eight first metatarsal osteotomies, four Achilles tendon lengthenings, and six Steindler strippings. Postoperatively, all eight patients returned to full ambulation, and the four ulcerations healed at an average of 24 days (range, 15–38 days). New ulceration occurred in one patient, and postoperative infection occurred in one patient. There were no ulceration recurrences, dehiscence of surgical sites, or minor or major amputations. Conclusions: The outcomes in patients surgically treated for increased plantar first metatarsal head pressure were evaluated. This case series demonstrates that our pragmatic, sequential approach yields positive results. In diabetic or high-risk patients, it is our treatment algorithm of choice for increased plantar first metatarsal pressure.
Chapter
Plantar heel pain is a common disorder of the foot which involves multiple anatomic structures.
Article
Full-text available
The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle. In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied. The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion. Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups.
Article
Full-text available
Accurate assessment of range of motion of the first metatarsophalangeal joint may assist the physical therapist when dealing with plantar fasciitis. The purpose of this study was to determine whether there is any difference in the amount of flexion and/ or extension at the first metatarsophalangeal joint in runners with plantar fasciitis. Bilateral active and passive range of motion values at the first metatarsophalangeal joint were measured with a goniometer on six subjects with plantar fasciitis and six subjects without the pathology while their leg was stabilized at the ankle and forefoot in an adapted orthosis. The results indicate a statistically significant decrease in active extension, passive extension, and passive flexion in runners with plantar fasciitis. Due to the loss of stability in the medial longitudinal arch which accompanies decreased extension range of motion at the first rnetatarsophalangeal joint, specific evaluation of this joint is needed when the physical therapist is treating a patient with plantar fasciitis. J Orthop Sports Phys Ther 1987;8(7):357-361.
Article
A sample of 60 subjects took part in a study of the mechanical role played by the very rigid plantar fascia, and the changes that occurred during active contraction of the toe flexor muscles, and when traction is applied to the plantar fascia by active dorsiflexion of the hallux. The data show that dorsiflexion of the hallux leads to a marked change in the height of the medial arc of the foot. The number of cases of plantar fasciitis treated today in sports clinics calls attention to the mechanical behaviour and function of this structure. The authors believe that it is indeed submitted to intense traction stress during running and jumping activities, when the hallux is constantly held in dorsiflexion.
Article
Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release.
Article
Structurally the foot is equivalent to a twisted plate. The hindpart is located in the sagittal plane and the forepart in the transverse plane. The transition induced by the twist creates the transverse and the longitudinal arches. Under vertical loading of the foot plate by the tibiotalar column, compressive forces are created on the dorsum and tensile forces on the plantar aspect of the foot plate. The plantar aponeurosis acting as a tie-rod when under tension relieves the tensile forces from the plantar aspect of the foot plate. The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes. In the plantigrade position when vertical loading and external rotation are simultaneously applied by the tibiotalar column on the foot, the hindfoot and the midfoot are supinated, and the forefoot is pronated. The medial longitudinal arch is higher, the foot is shorter, and the plantar aponeurosis is relaxed. The foot is then more flexible. With vertical loading and simultaneous internal rotation, the hindfoot and the midfoot are pronated, and the forefoot is supinated. The medial longitudinal arch is lower, the foot is longer, and the plantar aponeurosis is tense. The foot is then more rigid and a better lever arm. Demonstrations are presented both in living and in anatomic dissections.
Article
This study was designed to evaluate the dynamic support provided to the human longitudinal arch by the leg muscles active in the stance phase of gait and by the plantar aponeurosis. Ten fresh adult cadaveric specimens were mounted in a materials testing machine. The tendons of the posterior tibialis, flexor digitorum longus, flexor hallucis longus, peroneus longus, peroneus brevis, and Achilles tendon were attached to force transducers. Plantar loads of 0, 350 and 700 N were applied, and the tendons were tensioned individually. The Achilles tendon was tensioned an amount equal to the plantar load; the posterior tibialis, flexor digitorum longus, flexor hallucis longus, peroneus longus, and peroneus brevis were tensioned a fractional amount (depending on the proportion of the cross-sectional area to the gastrocsoleus complex). The angular relationships between the first metatarsal, navicular, and talus were recorded using a 3-dimensional movement analysis system. An additional series of measurements was obtained by positioning the ankle plantarflexed 10 degrees under a plantar load of 350 N. Dorsiflexing the toes with the ankle in a neutral position and loading the foot to 350 N and 700 N permitted an evaluation of the effect of the plantar aponeurosis. The plantar aponeurosis, via dorsiflexion of the toes, contributed the most significant arch support in the sagittal plane with a 3.6 degrees increase between the first metatarsal and talus at 350 N and a 2.3 degrees increase at 700 N. The posterior tibialis tendon consistently provided arch support at plantar loads of 350 N and 700 N. The peroneus longus consistently abducted the forefoot in the transverse plane at 350-N and 700-N load levels. The study provides further insight into the dynamic supporting and deforming forces of the longitudinal arch.