Plantar aponeurosis

What is Plantar Aponeurosis?

Plantar aponeurosis (PAA) is a condition where the top of your foot does not touch the ground when walking or running. Your toes are slightly higher than your heel. This condition may cause discomfort and pain in some cases. There are two types of PAA: Plantar fasciitis and Plantar aponeurotic stenosis (PAWS). PAWS is a less common condition, but it’s still very painful.

Causes of Plantar Aponeurosis

There are many possible causes of PAA. These include:

Trauma to the feet due to sports activities such as football, soccer, basketball and tennis. Running up stairs while carrying heavy bags or boxes. Walking with uneven terrain like when climbing steps or stepping over rocks. Walking on sharp objects.

Foot injuries such as sprains, strains, fractures and infections.

Infections such as fungal infections of the skin and soft tissue. Infection of the bones and joints (osteomyelitis). Injury to the tendons (muscles) around the ankle joint. Traumatic injury to the ligaments (tendons) that connect your foot to your leg (femur fracture).

Injuries to the nerves in your feet such as diabetic nerve damage.

Aging can sometimes affect the nerve and tissue in your feet.

Risk factors for developing PAA include having one or more of the following:

Having had a foot injury within the last year. Foot surgeries such as surgery to your ankle, heel, or bones in your foot. Certain diseases such as osteomyelitis (infected bone), tumors, or diabetes. An injury to the nerves in your feet. Certain genetic conditions such as neurofibromatosis or dysplasia.

Family history of PAA.

If you have any of these risk factors, you may be more prone to developing PAA.

Common signs and symptoms:

You might have PAA if you have one or more of these signs and symptoms:

Your foot turns in (pronates) excessively while walking or running. You might notice your foot rolling inward after stepping down off of a curb. Your toes or the inside of your foot may also turn up (evert) during this motion.

Your third and fourth toes may appear longer than your big toe.

The top of your foot may appear swollen, red or inflamed.

Pain, numbness or tingling in the bottom of your foot or in the middle of your arch.

The bottom of your foot may turn pale or blue when you’re standing for a long time.

You may hear a clicking, popping or cracking sound in your foot.

Your foot may feel stiff after you stop walking or if you’re just sitting down.

Plantar Fasciitis vs. Plantar Aponeurosis

Many people confuse plantar fasciitis with plantar aponeurosis, but they are different conditions. If you have one or more of the risk factors for PAA, your doctor may give you an ultrasound scan to look at your foot. In this case, you can request a copy of the report which will list the official medical diagnosis in the “Objective” section. The most common diagnoses for PAA are:

“Longitudinal aponeurotic tendon overgrowth”

“Aponeurotic proliferation of the plantar fascia”

“Aponeurotic web formation”

You may also have a tear in the aponeurosis, one or more calcaneal (heel bone) spurs or fat pads behind your calcaneal tuberosity. You can get an MRI to look at your foot and rule out any other diseases or conditions.

Prevention and treatment:

Surgery is the only way to completely cure PAA. Some foot doctors may give you a steroid injection to help relieve pain and reduce inflammation. Other treatments include:

Using ice or elevation to reduce any swelling in your foot.

Taking medicine such as ibuprofen, naproxen or acetaminophen for pain.

Using a cast or boot to keep your foot from moving.

Wearing a shoe that supports your foot and ankle when you walk or run.

Stretching and strengthening the muscles in your foot.

Physical therapy to improve joint motion.

Using a night splint to keep your foot from flexing while you sleep.

Wearing shoes with heels that are at least one inch high. This helps take pressure off the ball of your foot, which reduces strain on the tendon.

In some cases, a surgeon can remove part or all of the aponeurosis to eliminate pain and prevent the condition from worsening.

If you’re interested in having surgery or more foot and ankle treatments, ask your health insurance company for a referral. You can also look for a foot and ankle specialist at the American College of Foot and Ankle Surgeons website.

Achilles Tendonitis vs. Achilles Tendonosis

Many people confuse achilles tendonitis with achilles tendonosis. However, these two problems have different causes and treatments. The most common cause of achilles tendonitis is overuse, especially in athletes who participate in sports like running, basketball or soccer. Other risk factors include:

Having flat feet that cause you to pronate. (This means your ankles turn inward when you walk or run.

Sources & references used in this article:

The mechanics of the foot: II. The plantar aponeurosis and the arch by JH Hicks – Journal of anatomy, 1954 –

Dynamic loading of the plantar aponeurosis in walking by A Erdemir, AJ Hamel, AR Fauth, SJ Piazza… – JBJS, 2004 –

Ultrasound of the plantar aponeurosis (fascia) by WW Gibbon, G Long – Skeletal radiology, 1999 – Springer

Material properties of the plantar aponeurosis by HB Kitaoka, ZP Luo, ES Growney… – Foot & ankle …, 1994 –

The plantar aponeurosis by MR Hedrick – Foot & ankle international, 1996 –

Functional characteristics of the foot and plantar aponeurosis under tibiotalar loading by SK Sarrafian – Foot & ankle, 1987 –

Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain by GF Kogler, SE Solomonidis, JP Paul – Clinical Biomechanics, 1996 – Elsevier

Plantar aponeurosis and internal architecture of the ball of the foot. by F Bojsen-Moller, KE Flagstad – Journal of anatomy, 1976 –