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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 67 the dermis and strongly adhered to the plantar fascia, forming a tight tethering between the two that prevents gliding and helps the foot grip the ground. Without the supportive architecture of the fat pad and its stabilizing relationship to the skin and plantar fascia, walking would feel like slipping on banana peels with a constant risk of losing balance and falling. Looking specifically at the heel's fat pad, we find an extra layer of cushioning between the calcaneus and the skin. Deep to the micro lobules, we encounter larger, macro fat lobules. Approximately the size of mini marshmallows, the macro lobules are not as tightly constrained as their micro lobule counterparts, allowing them to deform slightly under loading and to provide a dampening effect for impact at the heel. 2 Try it: Moving just the skin on the top of your foot, note how it moves in many directions. Now, try the same on the bottom of your foot. How is it different? Gently traction the skin and subcutaneous fat layer. Can you feel the stiffer micro lobules that move with the skin? Working deeper at the heel pad, can you sense the macro lobules underneath? Can you feel the calcaneus tuberosity through all these protective tissues? EVEN DEEPER: THE PLANTAR FASCIA Deep to the fibrous fat pads, we find the plantar fascia . Tough in its own right, this thick, fibrous band of tendon- like connective tissue has a different composition than the fat pads, and a different job to do. The plantar fascia extends from the calcaneal tuberosity along the length of the sole of the foot. As it approaches the metatarsal bones, TAKEAWAY: Every step, hop, and jump puts immense strain on our plantar foot. Fortunately, a whole team of tough, resilient, and surprisingly sensitive tissues steps in to manage these mechanical loads. The specialized architecture of the heel pad provides extra cushioning under the calcaneal tuberosity. The heel's fibro- adipose tissue is organized into two layers: a superficial layer made of micro fat lobules that play a key stabilizing role, and a deep layer made of macro fat lobules that provide cushioning and shock absorption. Image courtesy of AnatomySCAPES.com. it spreads out into five slips that merge into the fascia surrounding each toe. 3 Observing the plantar fascia up close, you can clearly see perfectly aligned silvery-white collagen fibers running longitudinally from heel to toes. The f lat, dense construction of the plantar fascia is not optimized for cushioning, but for tensile loading. 4 Under tension, it helps propel us forward while walking. Increasingly recognized for its fascial continuities with the Achilles tendon and the posterior chain of the body, the plantar fascia also has many important connections locally. Deeply rooted into its surrounding tissues of skin, muscle, and bone, the plantar fascia is richly supplied with proprioceptive mechanoreceptors, indicating its guiding role in the control and stability of the entire foot. 5 Try it: Starting your palpation at the center of the plantar foot, sink in until you observe a change in tissue density at the plantar fascia. Place the plantar fascia under tension by flexing your ankle and then wiggling your toes, moving them through flexion and extension. Can you feel the plantar fascia tense and pop into your hands? Just under the skin, the entire plantar foot is supported by a layer of tough, fibro-adipose tissue composed of yellow micro fat lobules encased in a dense collagen network. This stabilizing, shock-absorbing layer is thickest where we need it most, forming fat pads under the heel, metatarsal joints, and toes. Image courtesy of AnatomySCAPES.com. 2 3