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The Journal of Bone and Joint Surgery (American) 86:546-552 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Dynamic Loading of the Plantar Aponeurosis in Walking

Ahmet Erdemir, PhD1, Andrew J. Hamel, PhD2, Andrew R. Fauth, MSc3, Stephen J. Piazza, PhD3 and Neil A. Sharkey, PhD3

1 Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH 44195
2 Stryker Endoscopy, 5900 Optical Court, San Jose, CA 95138
3 Center for Locomotion Studies (A.R.F., S.J.P., and N.A.S.), Department of Kinesiology (A.R.F., S.J.P., and N.A.S.), Department of Mechanical and Nuclear Engineering (S.J.P.), and Department of Orthopaedics and Rehabilitation (S.J.P. and N.A.S.), Pennsylvania State University, 29 Recreation Building, University Park, PA 16802-5702. E-mail address for S.J. Piazza: steve-piazza{at}psu.edu

Investigation performed at the Center for Locomotion Studies, Pennsylvania State University, University Park, Pennsylvania

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the International Society of Biomechanics and the Irma and Harold Zipser Fellowship. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The plantar aponeurosis is known to be a major contributor to arch support, but its role in transferring Achilles tendon loads to the forefoot remains poorly understood. The goal of this study was to increase our understanding of the function of the plantar aponeurosis during gait. We specifically examined the plantar aponeurosis force pattern and its relationship to Achilles tendon forces during simulations of the stance phase of gait in a cadaver model.

Methods: Walking simulations were performed with seven cadaver feet. The movements of the foot and the ground reaction forces during the stance phase were reproduced by prescribing the kinematics of the proximal part of the tibia and applying forces to the tendons of extrinsic foot muscles. A fiberoptic cable was passed through the plantar aponeurosis perpendicular to its loading axis, and raw fiberoptic transducer output, tendon forces applied by the experimental setup, and ground reaction forces were simultaneously recorded during each simulation. A post-experiment calibration related fiberoptic output to plantar aponeurosis force, and linear regression analysis was used to characterize the relationship between Achilles tendon force and plantar aponeurosis tension.

Results: Plantar aponeurosis forces gradually increased during stance and peaked in late stance. Maximum tension averaged 96% ± 36% of body weight. There was a good correlation between plantar aponeurosis tension and Achilles tendon force (r = 0.76).

Conclusions: The plantar aponeurosis transmits large forces between the hindfoot and forefoot during the stance phase of gait. The varying pattern of plantar aponeurosis force and its relationship to Achilles tendon force demonstrates the importance of analyzing the function of the plantar aponeurosis throughout the stance phase of the gait cycle rather than in a static standing position.

Clinical Relevance: The plantar aponeurosis plays an important role in transmitting Achilles tendon forces to the forefoot in the latter part of the stance phase of walking. Surgical procedures that require the release of this structure may disturb this mechanism and thus compromise efficient propulsion.


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