Fascia plantaire

The plantar fascia or plantar aponeurosis is the thick connective tissue aponeurosis which supports the arch on the bottom (plantar side) of the foot. Recent studies suggest that the plantar fascia is actually an aponeurosis rather than true fascia. It runs from the tuberosity of the calcaneus (heel bone) forward to the heads of the metatarsal bones (the bone between each toe and the bones of the mid-foot). The plantar fascia is the thick central portion of the fascia investing the plantar muscles. It extends between the medial process of the tuber calcanei and the proximal phalanges of the toes. It provides some attachment to the flexor muscles of the toes. Distally, the plantar fascia becomes continuous with the fibrous sheats enveloping the flexor tendons passing to the toes. At the anterior extremity of the sole - inferior to the heads of the metatarsal bones - the plantar aponeurosis forms the superficial transverse metatarsal ligament. The plantar fascia is made up of predominantly longitudinally oriented collagen fibers. There are three distinct structural components: the medial component, the central component (plantar aponeurosis), and the lateral component (see diagram at right). The central component is the largest and most prominent. In younger people the plantar fascia is also intimately related to the Achilles tendon, with a continuous fascial connection between the two from the distal aspect of the Achilles to the origin of the plantar fascia at the calcaneal tubercle. However, the continuity of this connection decreases with age to a point that in the elderly there are few, if any, connecting fibers. There are also distinct attachments of the plantar fascia and the Achilles tendon to the calcaneus so the two do not directly contact each other. Nevertheless, there is an indirect relationship whereby if the toes are dorsiflexed, the plantar fascia tightens via the windlass mechanism. If a tensile force is then generated in the Achilles tendon it will increase tensile strain in the plantar fascia.