Healthcare and Medicine Reference
Fig. 3.11 The formation of a heel spur by the osteoblasts which fill in under a pulled-away periosteum illustrates both the adaptability of
the connective tissue system and one limitation of the simplistic 'muscles attach to bones' concept.
plantar surface where it tears and inflames. If instead
the periosteum of the calcaneus gives way and comes
away from the bone, then the osteoblasts will fill in the
'tent' under the periosteum, creating a bone spur.
From heel to knee
As discussed in Chapter 2, the fasciae do not just attach
to the heel bone and stop (as is implied, for instance, in
Figs 3.6 and 3.11). They actually attach to the collage-
nous covering of the calcaneus, the periosteum, which
surrounds the bone like a tough plastic wrapping. If we
begin to think in this way, we can see that the plantar
fascia is thus continuous with anything else that attaches
to that periosteum. If we follow the periosteum around
the calcaneus, especially underneath it around the heel
to the posterior surface (following a thick and continu-
ous band of fascia - see Figs 3.12 and 3.15B), we find
ourselves at the beginning of the next long stretch of
track that starts with the Achilles tendon (Figs 3.12 and
Because the Achilles tendon must withstand so much
tension, it is attached not only to the periosteum but also
into the collagenous network of the heel bone itself, just
as a tree is rooted into the ground. Leaving the calcaneus
and its periosteum, our train passes up, getting wider
and flatter as it goes. Three myofascial structures feed
into the Achilles tendon: the soleus from the profound
side, the gastrocnemius from the superficial side, and
the little plantaris in the middle (Fig. 3.12).
Fig. 3.12 Around the heel, there is a strong and dissectable
fascial continuity between the plantar fascia and the Achilles
tendon and its associated muscles.