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June 6, 2023

IASTM: Plantar and Crural Fascia (Lower Leg)

Learn all about IASTM therapy for plantar and crural fascia in the lower leg. Discover the benefits and how it can relieve pain and improve mobility.

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

IASTM: Plantar and Crural Fascia (Lower Leg)

By Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Plantar Fascia (13:38)

Crural Fascia (21:18)

Crural Fascia

The crural (lower leg) fascia presents with a mean thickness of 924 μm (μm = micrometer = 1/1000 mm), and is composed of two or three layers of collagen fiber bundles with a mean thickness of 277.6 μm. A thin layer of loose connective tissue, with a mean thickness 43 μm, usually separates the different layers. In each layer, a prevalent direction of the fibers is recognizable, forming angles of 80–90° to those in adjacent layers (146, 147). Surprisingly, elastin only exists at the borders of the crural fascia and in loose connective tissue, and is nearly absent in the layers of overlapping deep fascia (146). This may imply that restrictions are not due to a loss of "elasticity," but rather movement between layers, or binding between layers that does not allow for the "uncrimping" of the wavy fascial sheaths. Although more research is needed, this hypothesis does seem to favor instrument assisted soft tissue mobilization (IASTM), pin and stretch and other myofascial techniques that create shear forces between layers of tissue. Treatment of the crural fascia with IASTM and Pin-and-Stretch techniques has proven effective in practice, especially relative to enhancing carry over of mobility gains.

Plantar Fascia

The plantar fascia is an important fascial structure, aiding in stabilization of the medial longitudinal arch of the foot, resisting pronation and increasing the rigidity necessary for push-off during gait (via the "windlass mechanism"). The importance of this structure can be seen in the effect rupture/release of the plantar fascia has on the mechanics of the foot, generally resulting in pes planus (feet flatten ) (152, 153). The plantar fascia has been implicated as a source of injury/dysfunction, commonly resulting in complaints of pain around the medial tubercle of the calcaneus, generally worst with the first few steps upon waking, and commonly diagnosed as plantar fasciitis (154). This set of symptoms and diagnosis has been shown to be linked to altered biomechanics, including feet flatten and a loss of dorsiflexion (admittedly, an assumption is being made that the loss of dorsiflexion is correlated with the increase in forefoot pressure in the studies cited) (155, 156). As mentioned above this dysfunction results in a thickening of the plantar fascia, a loss of extensibility, and perhaps an increased risk of rupture (weakening) (157, 158). It is important that these changes are carefully considered before interventions are selected. If a loss of extensibility is due to inflammation and being "stuck" in a lengthened position due to feet flatten and a loss of dorsiflexion , rolling the bottom of the foot on a ball cannot be expected to have any long-term positive affect. Correction of biomechanics, reducing stress on the plantar fascia and methods of reducing inflammation may be more pertinent means of addressing the issue.

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