Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading.

Abstract

With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.