THE EFFECTS OF PLANTAR FASCIITIS ON WINDLASS

MECHANISM
This windlass mechanism is a mechanical model that describes the manner
which plantar fascia supports the foot during weight-bearing activities and
provides information regarding the biomechanical stresses placed on plantar
fascia.

The calcaneus, midtarsal joint, and metatarsals (the medial longitudinal arch)
formed the truss's arch. The plantar fascia formed the tie-rod that ran from the
calcaneus to the phalanges. Vertical forces from body weight travel downward
via the tibia and tend to flatten the medial longitudinal arch. Furthermore,
ground reaction forces travel upward on the calcaneus and the metatarsal
heads, which can further attenuate the flattening effect because these forces
fall both posterior and anterior to the tibia. The plantar aponeurosis originates
from the base of the calcaneus and extends distally to the phalanges.

A “windlass” is the tightening of a rope or cable. The plantar fascia simulates a

cable attached to the calcaneus and the metatarsophalangeal joints.
Dorsiflexion during the propulsive phase of gait winds the plantar fascia
around the head of the metatarsal. This winding of the plantar fascia shortens
the distance between the calcaneus and metatarsals to elevate the medial
longitudinal arch. The plantar fascia shortening that result from hallux
dorsiflexion is the essence of the windlass mechanism principle.

PERFORMING THE TEST

NON-WEIGHT BEARING POSITION: 

Passively raise the toes of the patient while he/she is sitting to see whether this
causes pain.
 Patient’s knee is flexed to 90° while in non-bearing position
 Examiner stabilized the ankle (with one hand placed just behind the
first metatarsal head)  and extends the MTP joint while allowing the
IP to flex (preventing motion limitations due to short hallucis longus)
  Positive test if pain was provocated at the end range of the MTP
extension

WEIGHT-BEARING POSITION: 
With the patient in a weight bearing position, the examiner creates a great toe
extension
 The patient stands on a step stool and positions the metatarsal of heads
of the foot to be tested just over the edge of the step.
 The subject is instructed to place equal weight on both feet.
 The examiner then passively extends the first metatarsophalangeal joint
while allowing the interphalangeal joint to flex.
 Passive extension (i.e., dorsiflexion) of the first metatarsophalangeal
joint is continued to its end of range or until the patient’s pain is
reproduced.