Healthcare and Medicine Reference
In-Depth Information
down on the table. In these cases, it is the medial edge
of the plantar fascia that needs lengthening.
If the outer aspect of the foot is short - if the little toe
is retracted or the 5th metatarsal base is pulled toward
the heel, or if the outer aspect of the heel seems pulled
forward - then the outer edge of the plantar fascia,
especially its lateral band, needs to be lengthened (DVD
ref: Superficial Back Line, 20:29-22:25). This pattern often
accompanies a weak inner arch and the dumping of the
weight onto the inner part of the foot, but can occur
without the fallen arch.
Even in the relatively balanced foot, the plantar
surface can usually benefit from enlivening work to
make it more supple and communicative, especially in
our urbanized culture where the feet stay locked up in
leather coffins all day. A default approach to the plantar
tissues is to lengthen between each of the points that
support the arches: the heel, the 1st metatarsal head, and
the 5th metatarsal head (Fig. 3.9).
from the ball of all five toes back to the front edge of the
heel, the whole triangle shown in Figure 3.9.
Now have the client do the forward bend again and
note the bilateral differences in back contour and hand
position (and draw the client's attention to the differ-
ence in feeling). In most people this will produce a dra-
matic demonstration of how working in one small part
can affect the functioning of the whole. This will work
for many people, but not all: for the most easily assess-
able results, avoid those with a strong scoliosis or other
bilateral asymmetries.
Since this also functions as a treatment, do not forget
to carry out the same procedure on the other side after
you assess the difference.
Heel spurs
It is 'common knowledge' that the muscles attach to
bones - but this commonsense view is simply not the
case for most myofasciae. The plantar fascia is a good
case in point. People who run on the balls of their feet,
for instance, or others who for some reason put repeti-
tive strain on the plantar fascia, tug constantly on the
calcaneal attachment of the plantar fascia. Since this
fascia is not really attached to the calcaneus but rather
blends into its periosteal 'plastic wrap' covering, it is
possible in some cases for the periosteum to be progres-
sively tugged away from the calcaneus, creating a space,
a kind of 'tent', between this fabric and the bone (Fig.
3.11).
Between most periostea and their associated bones lie
many osteoblasts - bone-building cells. These cells are
constantly cleaning and rebuilding the outer surface of
the bone. In both the original creation and the continu-
ing maintenance of their associated bone, the osteoblasts
are programmed to fill in the bag of the periosteum.
Clients who create repetitive strain in the plantar fascia
are likely to create plantar fascitis anywhere along the
A simple test
For a sometimes dramatic and easily administered test
of the relatedness of the entire SBL, have your client do
a forward bend, as if to touch the toes with the knees
straight (Fig. 3.10). Note the bilateral contour of the back
and the resting position of the hands. Draw your client's
attention to how it feels along the back of the body on
each side.
Have your client return to standing and roll a tennis
ball (or a golf ball for the hardy) deeply into the plantar
fascia on one foot only, being slow and thorough rather
than fast and vigorous. Keep it up for at least a couple
of minutes, making sure the whole territory is covered
— Base of
5th metatarsal
Fig. 3.10 A forward bend
with the knees straight links
and challenges all the tracks
and stations of the Superficial
Back Line. Work in one area,
as in this move for the plantar
fascia, can affect motion and
length anywhere and
everywhere along the line.
After work on the right plantar
surface, the right arm hangs
lower.
Lateral band
Fig. 3.9 The plantar aponeurosis forms a 'trampoline' under the
arches - one springy arch between each point of contact: the 5th
metatarsal head, the 1st metatarsal head, and the heel.
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