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Feet First: Clinical Pearl for the Feet #2

2. Our Plantar Fascia is Overused (that is often why we have so many issues with it) and relies on the successful implementation of something called the windlass mechanism.


Do you know if you have an operational windlass mechanism during your gait? Did you know you had a windlass mechanism? If people are familiar with a structure in the foot, it is most often the plantar fascia, and the ubiquitous plantar fasciitis that can develop when the tissue becomes irritated.

We’ll take a closer look into why this tissue is so commonly irritated (hint: think IT band syndrome), and even more importantly, what you can do about it.


Our plantar fascia is a beautiful expansion of dense connective tissue (fascia) that runs along the plantar aspect (bottom) of our feet. Most of our problems with our plantar fascia, arise from the fact that we are not optimizing the musculature that dwells deep to it to support us, and we have become over reliant on the passive fascia to provide more support that it was made to.


Our feet and ankles are subjected- daily and repetitively to forces from the weight of the body bearing down on them, and also forces from the ground they traverse over (known as ground reaction forces). In order to overcome and support the tremendous effort required by the feet daily, there are some wonderful structural support systems within the foot. Perhaps the most well-known and important is the windlass mechanism.


The term windlass is a verb used in sailing to denote lifting or hauling using mechanical leverage. The simple mechanics at work in the foot are essentially for the same exact reason- to haul and move the weight of the body using the small appendage of the big toe/ foot- quite extraordinary when you think about it!


In fact, in our healthful gait cycle, there is a time in the movement when our full body weight is essentially supported by the big toe. Without the windlass mechanism, these forces are too great and ultimately cause a host of compensatory movements- over reliance on the plantar fascia, “toeing out” and pushing off the medial aspect of the big toe, heel whipping- or a combination of these strategies and more.


During a successful windlass, when our full body weight is carried by the big toe, the toe extension position tightens the plantar fascia, pulling the mid foot and heel (calcaneus) into a slight inverted/ supinated position. This creates an immediate stiffness/ rigidity in the foot- and in this case, we want this stiffness as a rigid foot helps to propel us forward.


We do a test in the clinic when we suspect that the windlass mechanism, is broken down (if you are interested in finding out if yours is, please schedule an appointment for an evaluation with your local physical therapist, as this test is not possible to DIY). Even if you have stretched out your plantar fascia and broken down this mechanism, all is not lost!

You can begin by restoring strength and mobility at the big toe and ankle (per our blog last week, check out here).

The strengthening exercises from last week are a wonderful start, but at some point, you must move to weight bearing. I recommend getting super familiar with heel lifts:


Heel Lifts:

Stand close to a wall. You can use the wall for support. Lift both heels and lower. If you have any pain with this exercise, proceed with option A. If no pain option B:


-Have a comfortable seat. Grab your theraband and wrap your theraband around the bottom of your foot. Gently push into the resistance of the band, like pushing your foot onto a gas pedal. Hold 3 seconds. Release the position slowly, taking a slow count of 3 to return to the start. Repeat 30 times, 2-3 times.


-Standing: press your big toe and pinky toes down into the ground. Lift your heels, keeping your weight balanced between your big and little toes. Hold 1 second, then slowly lower back down to start, taking 3 seconds to do so. If this feels easy and pain free, please try single leg. Make sure not to bend your knee. Work up to 20-30 repetitions of single leg on each side (20 single leg heel lifts with good form are necessary for healthful walking).


Enjoy- stay challenged and safe. Remember it takes 6 weeks for true strength gains.


Happy Moving!


Trina





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