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# Plantar fascia

The plantar fascia is a thick band under the sole from the heel to the toes; it supports the arch and can cause heel pain when irritated.

Official name: Plantar aponeurosis

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## What it is

A thick, fibrous band along the sole, from the bottom of the heel bone to the base of the toes.

## What it does

Supports the arch like a bowstring. It tightens when the toes bend up, making the foot firm for push-off.

## Key points

- Three parts: a thick central band (the one that matters clinically) and thinner medial and lateral bands; the central band splits into five slips
- Windlass mechanism: bending the toes up winds the fascia around the metatarsal heads, shortening the foot, raising the arch and turning the heel inward, so the foot becomes a rigid lever for push-off
- Plantar fasciitis pain sits at the medial calcaneal tubercle; chronic cases are degenerative (fasciosis) rather than inflammatory
- Heel pain mimics: entrapment of the first branch of the [lateral plantar nerve](https://durgical.com/en/anatomy/lateral-plantar-nerve/) (Baxter's nerve), calcaneal stress fracture, fat pad atrophy and tarsal tunnel syndrome

## Key facts

**Attaches**
Medial process of calcaneal tuberosity to five slips into plantar plates and fibrous flexor sheaths of toes

**Function**
Supports longitudinal arch; windlass mechanism raises arch on toe dorsiflexion; plantar fasciitis at heel

**Tight in**
Dorsiflexion of toes (especially hallux) with ankle dorsiflexion

## Relations

**Course**
From the calcaneal tuberosity it widens forward; near the metatarsal heads each slip splits around the flexor tendons to reach the plantar plates and deep transverse metatarsal ligaments, with fibres to the [skin](https://durgical.com/en/anatomy/skin/) creases

**Superficial**
Heel fat pad, built of fat in fibrous chambers, and the skin of the sole

**Deep**
First layer of sole muscles: [flexor digitorum brevis](https://durgical.com/en/anatomy/flexor-digitorum-brevis/) (which arises from its deep surface), [abductor hallucis](https://durgical.com/en/anatomy/abductor-hallucis/) and abductor digiti minimi

**Medial**
Baxter's nerve, passing between the abductor hallucis and the [quadratus plantae](https://durgical.com/en/anatomy/quadratus-plantae-muscle/) close to the fascia's origin

## How to find it

With the ankle and toes bent up, especially the [big toe](https://durgical.com/en/anatomy/great-toe/), the medial edge of the fascia stands out as a taut cord in the sole. The tender point of plantar fasciitis is at the front of the heel pad, over the medial calcaneal tubercle.

## Examination

- Windlass test: passive dorsiflexion of the big toe (standing or sitting) reproduces heel pain; specific for plantar fasciitis, though often negative
- Point tenderness at the medial calcaneal tubercle supports plantar fasciitis; pain when the heel is squeezed from both sides suggests a calcaneal stress fracture instead
- Silfverskiöld test: ankle dorsiflexion improves when the knee is bent if the gastrocnemius is tight, a common association

## On imaging

Ultrasound shows a thickened, darker origin (more than about 4 mm is the usual cut-off) compared with the other side; MRI shows thickening, partial tears and calcaneal bone oedema. A plantar heel spur on X-ray is common in people without pain and sits mostly in the flexor digitorum brevis origin.

## Common problems

- Plantar fasciitis: heel pain, worst with the first steps in the morning or after rest. Common in runners, people who stand all day and people with extra weight.
- Partial tears, sometimes after a sudden push-off.
- Small lumps in the band (plantar fibromatosis).

## How it is diagnosed

Usually the history and a physical exam. Ultrasound or MRI can show a thickened fascia. X-rays may show a heel spur, which is often not the cause of the pain.

## Treatment

- Most people get better without surgery: stretching the calf and the fascia, supportive shoes or inserts, night splints and activity changes.
- Ongoing pain: physical therapy, injections or shock-wave therapy.
- Surgery to partly release the fascia, for the few people who do not improve after many months.

## Clinical notes

- Rupture can follow a sudden push-off and is linked to previous steroid injections; the arch may flatten afterwards
- Release surgery divides only the medial part, because a complete release can flatten the arch and overload the lateral column
- Plantar fibromatosis (Ledderhose disease) forms nodules in the central band and is linked to Dupuytren's disease of the hand

## Memory aid

Windlass: "toes up, arch up".

## Related conditions

- [Plantar Fasciitis](https://durgical.com/en/conditions/plantar-fasciitis/)

## Test yourself

Think of the answer, then tap the question to see it.

## What are the attachments of the plantar fascia?

From the medial process of the calcaneal tuberosity to five slips into the plantar plates and fibrous flexor sheaths of the toes.

## What is the windlass mechanism of the plantar fascia?

Bending the toes up winds the fascia around the metatarsal heads, raising the arch so the foot becomes a rigid lever for push-off.

## Where is the point tenderness of plantar fasciitis, and what does pain on side-to-side heel squeeze suggest instead?

At the medial calcaneal tubercle; pain on squeezing the heel from both sides suggests a calcaneal stress fracture.

## Why does plantar fascia release surgery divide only the medial part?

A complete release can flatten the arch and overload the lateral column.

## Which nerve entrapment mimics plantar fasciitis heel pain?

Baxter's nerve, the first branch of the lateral plantar nerve, trapped between the abductor hallucis and the quadratus plantae.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
aponeurosis plantaris TA2 2718

**Official Spanish (DeCS)**
Aponeurosis plantar

**English (TA2)**
Plantar aponeurosis

## Related

- [Calcaneus](https://durgical.com/en/anatomy/calcaneus/)
- [Flexor digitorum brevis](https://durgical.com/en/anatomy/flexor-digitorum-brevis/)
- [Abductor hallucis](https://durgical.com/en/anatomy/abductor-hallucis/)
- [Abductor digiti minimi](https://durgical.com/en/anatomy/abductor-digiti-minimi-of-foot/)
- [Plantar arteries](https://durgical.com/en/anatomy/medial-plantar-artery/)

Sources: Terminologia Anatomica (TA2); [Anatomy, Bony Pelvis and Lower Limb, Foot Fascia](https://www.ncbi.nlm.nih.gov/books/NBK526043/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/plantar-aponeurosis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/plantar-aponeurosis/