Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures

Abstract

Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p<.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p<.05).

Anatomical variations of the plantar fascia's origin with respect to age and sex—an MRI based study

“…The PF plays a significant role in both static and dynamic function of the foot by supporting the arch (Boussouar et al, ; Guo et al, ; Orner et al, ; Park et al, ). Originating from CB in close proximity to the AT and expanding toward the metatarsal bones where it inserts, the PF may also highly influence the biomechanical properties of the surrounding structures (Aydogan et al, ; Angin et al, ). Anatomical variations of the origin of the PF may therefore affect the foot's biomechanical properties with potential significance in foot pathologies.…”

“…Pathologies of the PF may not only highly influence the functional properties of the connective tissue itself, but also the overall biomechanical properties of the foot (Cheung et al, ; Aydogan et al, ; Angin et al, ; Guo et al, ). However, it is important to notify that pathologies involving the surrounding structures may also significantly alter the functional properties of the PF (Li and Muehleman, ).…”

“…By supporting the arch of the foot, this connective tissue plays a significant role in terms of foot biomechanical properties and its mobility (Boussouar et al, ; Guo et al, ; Park et al, ). While standing, the arch of the foot together with PF may highly influence the foot's ability to carry load from the body weight (Cheung et al, ; Aydogan et al, ; Angin et al, ; Guo et al, ; Park et al, ). Since PF originates from CB, which is where the Achilles tendon (AT) inserts, the functional properties of PF may also be highly influenced by AT (Pękala et al, ; Orner et al, ) (Fig.…”

“…). The relationship between PF and AT has been cited to critically influence the biomechanics of the foot, however, this has not been clearly delineated (Carlson et al, ; Cheung et al, ; Aydogan et al, ).…”

Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model

“…A previously described mechanical loading setup by our institution was used. 2,3,11 Briefly, the tibia potting was fastened to the vertical actuator of a servohydraulic test frame (FlexTest 40, MTS, Eden Prairie, MN). Tension was applied to the Achilles with a pneumatic cylinder.…”