The plantar fascia is the thick fibrous band maintaining the medial arch passively and dynamically via the windlass mechanism. The central band is the largest and most clinically important component — its medial calcaneal tuberosity origin is the site of plantar fasciitis. The windlass mechanism (first MTP dorsiflexion tightening the fascia) is essential for toe-off — loss of the windlass effect from plantar fascia attenuation produces the 'windlass failure' of severe flatfoot.
| Origin | Medial calcaneal tuberosity (all three bands: medial, central, and lateral) |
|---|---|
| Insertion | Bases of the proximal phalanges of all five toes via the plantar plates and pretendinous fibres |
| Actions | Windlass mechanism — passive tensioning of the plantar fascia during toe dorsiflexion elevates the medial arch and converts the foot into a rigid lever for push-off; supports the medial longitudinal arch passively |
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Plantar fasciitis (plantar heel pain) is the most common foot complaint, affecting 10% of the population. First-step morning pain that warms up is the pathognomonic symptom from plantar fascia tightening overnight. First-line: stretching (plantar fascia and calf), night splints, orthotics, shoe modification. Second-line: corticosteroid injection (short-term relief, risk of fascia rupture), PRP (better long-term). Third-line: ultrasound-guided needle fasciotomy or plantar fasciotomy.
Calcaneal enthesopathy from plantar fascial overload producing morning first-step heel pain managed with stretching, orthotics, injection, and progressive loading.
