Plantar fasciitis and ruptures of the plantar aponeurosis are diseases of the sole of the athlete's foot, which can appear in sports that involve pushing or jumping, such as athletics, gymnastics and dance.
to the fingers during activities such as walking, running, or jumping; moreover, its visco-elasticity allows to return, by elastic distension, a large amount of energy to each stride or to each jump.The plantar aponeurosis comprises an external part, an internal part and an intermediate part; of these three parts, the intermediate part is the one most affected by fasciitis, micro-tears and ruptures.
, usually accentuated in correspondence of the posterior and internal tuberosity, irradiated along the internal margin of the aponeurosis both during movement and on palpation.
The tensioning of the aponeurosis, in dorsiflexion of the fingers and ankle, triggers the pain.
Ultrasound shows irregularities in the fascia insertion area and may highlight a "heel spur" which demonstrates overstressing of the plantar fascia.
The treatment includes:
- Decompressive bandage in the acute phase and use of visco-elastic insoles;
- Stability bandage, in the sporting re-entry phase.
On palpation, pain along the plantar fascia is appreciated which prevails in correspondence with the posterior tubercle, the preferred site of the rupture.
, in:
- Traumatic;
- Microtraumatic;
- On a dysmetabolic and / or inflammatory basis.
Micro-traumatic tendinopathies are also defined as functional overload injuries, capable of determining the pathology with a direct and an indirect mechanism.
This type of injury can lead to the rupture of the plantar aponeurosis, which however represents the acute episode following a degenerative process (tendinosis); the latter, sometimes almost completely asymptomatic or preceded and accompanied by episodes of painful inflammation, and involving more or less extensively the tendon-aponeurotic structure, causes a decrease in mechanical resistance, which can be overcome by a " sudden stress, even if not excessive.
Functional overload of the plantar fascia: the causes
The factors that can cause overload pathologies in the tendons (and in many cases also in the muscles), of the instep and of the foot can be generically divided into intrinsic and extrinsic, and act in a variable percentage from subject to subject.
Intrinsic Factors
As for the intrinsic factors, these are essentially:
- Anatomical variability, resulting in a more or less marked alteration of the normal biomechanics of walking or athletic movement, which subjects the instep and foot to abnormal stress.
More specifically, one of the main problems is overpronation of the instep and foot during running, which has a whipping action, like a bowstring, on the plantar aponeurosis, resulting in a high frequency of inflammation; - Dysmetabolic diseases, which can favor local inflammatory reactions, as well as cause the alteration of the composition of the normal tendon tissue up to determining a more precocious aging;
- Last but not least, the age of the individual, the years of competitive activity and any overweight-sports. In fact, the aging of the tendon tissue causes a metabolic slowdown of the tissue collagen, with a gradual decrease in the cell-matrix ratio in favor of the latter, a decrease in the water content of the elastic fibers, proteoglycans and glycoproteins.
Furthermore, the blue line present at the osteo-tendon junctional level disappears, which plays an "important modulating and shock-absorbing action against mechanical stresses.
Extrinsic factors
As far as extrinsic factors are concerned, they often become decisive in the establishment of overload tendinopathy in the instep and foot.
There are three main factors:
- The incongruous training;
- The competition or training grounds;
- The shoe.
By Professor Rosario Bellia - Professor of Kinesiological Taping® at the State University of Valencia (Spain) - Physiotherapist of the Italian national team of the F.I.H.P.
