Massage & Bodywork

MAY | JUNE 2023

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66 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 3 The soles of our feet are under a lot of stress—mechanical stress. Consider how much we rely on our plantar foot to quietly manage some pretty impactful tasks, from bearing our body weight as we stand at the massage table to absorbing impact as we walk, run, or jump. Our feet are able to meet the challenges of compression, shock absorption, shearing, and tensile loading with specialized tissues that are tough, resilient, and surprisingly sensitive. Anatomy education sometimes focuses on isolated structures, but when it comes to understanding function, we have to widen our view—it takes a village of different tissues working together to get the job done. Let's take a tour of the plantar foot— from surface to deep—to get better acquainted with three of these stress- management specialists. SURFACE: THE SKIN Shoes first appeared in the human story about 10,000 years ago (with running shoes not making their debut until 1852). Before that, we had our skin. Fortunately, plantar skin is highly specialized and well-suited for the job of repetitive weight-bearing and negotiating abrasive terrains during locomotion. It needs to be tough enough to protect itself from injury, as well as be able to "take one for the team" by off loading external stresses before they impact the rest of the foot. The scientific term for specialized plantar skin is thick skin or glabrous skin. It's characterized by a protective epidermis that critical thinking | ANATOMY FOR TOUCH The Plantar Foot—from Surface to Deep A Shock(absorb)ing Story By Nicole Trombley and Rachelle Clauson The tightly packed, silvery-white collagen fibers of the plantar fascia fan out from the heel (bottom of image) and extend longitudinally along the sole of the foot to the toes. The superficial tissues have been reflected, exposing the small, yellow fat lobules encased in a dense, fibrous network of skin ligaments. Tethering fibers that are continuous from the skin to the plantar fascia remain at the middle and top of the image, illustrating the remarkable stability of the plantar foot's architecture. Image courtesy of 1 handle the extra friction and shearing forces that come with increased barefoot time. Even with all that epidermis thickening, the plantar skin is exquisitely sensitive, equipped with sensory nerve endings and proprioceptive mechanoreceptors. Sensitivity is so essential to the skin's protective role that it's preserved even in thickly callused skin. 1 Try it: Keeping your touch superficial, explore the skin on the sole of your foot. Where is your skin thickest? How does it compare with the skin on the top of the foot? What areas are most sensitive? GOING DEEPER: FAT PADS The toughness of the plantar foot doesn't stop at the skin. Immediately beneath the dermis, we encounter fibrous fatty tissue: the plantar fat pads. While the word "fat" often has a connotation of soft or weak, make no mistake: this fibro-adipose tissue is designed for work. The fat pads are thickest under the heel and metatarsal joints and work with the skin as a shock-absorbing stabilizer. The fat pads are made of micro-sized fat lobules that look like tightly packed, tiny, yellow beads. Measuring just 1–2 millimeters in diameter, each micro lobule is nearly incompressible, hardly deforming at all when under load due to its encasement in a dense, three-dimensional collagen network of specialized septa (skin ligaments). The septa are continuous with is far thicker than skin found elsewhere on the body and with the ability to thicken further in response to strain. We recognize this familiar response as calluses. After a few weeks of walking barefoot in the summer, the epidermis on the bottom of your feet will have toughened and thickened by adding more keratinized layers. These new layers create a reinforced protection to

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