Healthcare and Medicine Reference
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from knee to toes. (Contrast this leverage with the prox-
imity of the joint-stabilizing muscles: the fibularii (pero-
neals) of the Lateral Line that snake right around the
lateral malleolus and the deep toe flexors of the Deep
Front Line that pass close behind the medial
malleolus.)
To see the clinical problem this patterning can create,
imagine this lower section of this Superficial Back fascial
line - the plantar fascia and Achilles-associated fascia -
as a bowstring, with the heel as an arrow. As the SBL
chronically over-tightens (common in those with the
ubiquitous postural fault of a forward lean of the legs
(an anterior shift of the pelvis), it is capable of pushing
the heel forward into the subtalar joint; or, in another
common pattern, such extra tension can bring the
tibia-fibula complex posteriorly on the talus, which
amounts to the same pattern. (Fig. 3.15).
To assess this, look at your client's foot from the
lateral aspect as they stand, and drop an imaginary ver-
tical line down from the lower edge of the lateral mal-
leolus (or, if you prefer, place your index finger vertically
down from the tip of the malleolus to the floor). See how
much of the foot lies in front of this line and how much
behind. Anatomy dictates that there will be more foot
in front of the line, but, with a little practice, you will be
able to recognize when there is comparatively little heel
behind this line (Fig. 3.16A and B).
Measure forward from the spot below the lateral mal-
leolus to the 5th metatarsal head (toes are quite variable,
so do not include them). Measure back from the spot to
the place where the heel leaves the floor (and thus offers
no support). On a purely empirical clinical basis, this
author finds that a proportion of 1:3 or 1:4 between the
hindfoot and the forefoot offers effective support. A
ratio of 1:5 or more indicates minimal support for the
back of the body. This pattern cannot only be the result
of tightness in the SBL but also the cause of more tight-
ness as well, as it is often accompanied by a forward
shift at the knees or pelvis to place more weight on the
forefoot, which only tightens the SBL further. As long
as this pattern remains, it will prevent the client from
feeling secure as you attempt to rebalance the hips over
the feet.
To those who say that this proportion is determined
by heredity, or that it is impossible for the calcaneus to
move significantly forward or backward in the joint, we
suggest trying the following:
• release the plantar fascia, including the lateral band,
in the direction of the heel (DVD ref: Superficial Back
Line, 10:57-16:34, 20:29-22:25)
• release the superficial posterior compartment of
the leg (soleus and gastrocnemius) down
toward the heel (DVD ref: Superficial Back Line,
22:27-24:30)
• mobilize the heel by stabilizing the front of the
tarsum with one hand while working the heel
through its inversion and eversion movements in
your cupped hand.
In more recalcitrant cases, it may be necessary to
further release the ligaments of the ankle by working
Fig. 3.13 A dissection of the heel area demonstrates the
continuity from plantar tissues to the muscles in the superficial
posterior compartment of the leg. (© Ralph T Hutchings.
Reproduced from Abrahams et al 1998.)
Let us take this first connection we have made - from
the plantar fascia around the heel to the Achilles tendon -
as an example of the unique clinical implications that
come out of the myofascial continuities point-of-view.
Heel as arrow
In simple terms, the heel is the patella of the ankle, as
we can see in the X-ray of a foot (Fig. 3.14). From a
'tensegrity' point of view, the calcaneus is a compression
strut that pushes the tensile tissues of the SBL out away
from the ankle and creates proper tone around the back
of the tibio-talar fulcrum, with the soft tissue spanning
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