Step by Step ScienceBiomechanical Concepts

As part of our training here at Foot Focus Podiatry, we have David Survepalli, one of our Principal Podiatrists who is Board Certified in Endorsement for Scheduled Medicines, has completed qualifications in Glascow, UK, Australia and New Zealand and has several publications dated from 2010-2023. We at Foot Focus Podiatry currently meet monthly as a whole team where David shares more about lower limb biomechanics.

Our most recent training was on the Achilles insertion (where the tendon attaches to the heel bone) and more about plantar fasciitis and how they relate to each other.

If you’d like to learn more, please read the information below!

📅 Want a clear plan for your heel pain? If you’re dealing with Achilles pain, plantar fascia pain, or stubborn heel symptoms and want a tailored plan, you can book an appointment online with Foot Focus Podiatry.
Book online: https://footfocuspodiatry.com.au

Biomechanical Concepts in Podiatry

Understanding how tissues respond to load is essential in podiatry because pain often reflects a mechanical problem before it becomes a structural one. Concepts such as elasticity, stiffness, deformation, and viscoelasticity help explain why the same activity can affect the Achilles tendon, plantar fascia, and other lower-limb tissues differently. Biomechanical thinking also helps clinicians choose treatments that reduce stress, improve load tolerance, and support long-term rehabilitation.

Why Tissue Mechanics Matter

• Elasticity: how well tissue returns to its resting length after a force is removed.
• Stiffness: how strongly tissue resists changing shape when load is applied.
• Deformation: the actual change in length/shape that occurs under load.
• Viscoelasticity: tissue behaves like a mix of a spring + shock absorber, storing and releasing energy over time.
• Why it matters clinically: either too much or too little stiffness can change how forces are shared through the foot and ankle—and may contribute to pain.

If you’re interested in reading more about Plantar Fasciitis and the Achilles insertion in the heel, please read below!

Achilles Tendon and Plantar Fascia

The Achilles tendon and plantar fascia are mechanically linked through the posterior chain, even though their fibres do not directly continue into one another. Force can still be transmitted between these structures through the periosteal connection at the calcaneus, which helps explain why problems in one area may influence the other. This connection is clinically important when assessing heel pain, calf function, and foot loading patterns.

🦶 Not sure whether it’s Achilles, plantar fascia, or both? An assessment can help identify what’s being overloaded and what to change first.
Book online: https://footfocuspodiatry.com.au

Insertional Achilles Tendinopathy

Pain at the Achilles insertion may reflect excessive force transmission at the calcaneal attachment. In these cases, management should prioritise improving calf capacity and load tolerance rather than aggressively stretching the tendon, because excessive stretch may increase compressive stress at the insertion. A biomechanical approach encourages clinicians to consider whether local stiffness is contributing to the symptoms and whether load management is the better first step.

Midportion Achilles Tendinopathy

Midportion Achilles pain is often discussed in relation to tendon fibre twisting and compression, which may contribute to reduced tissue quality, local hypoxia, tendon thickening, and degenerative change. In this setting, controlled stretching and eccentric or progressive loading may help improve tendon adaptation and reduce interfascicular compression. The key is matching the loading strategy to the location and likely mechanical behaviour of the tissue.

Plantar Fascia Pain

A similar framework applies to plantar fascia disorders, especially pain at the medial calcaneal tubercle where loading is concentrated. Excessive stiffness in the plantar fascia may increase insertional stress, while the posterior chain’s force-sharing capacity may influence how much strain the fascia experiences. Research has also reported relationships between plantar fascia and Achilles tendon mechanical properties, supporting the idea that the two structures should be considered together during assessment.

Tissue Stiffness as a Differential Diagnosis (Plantar Fasciitis / Plantar Heel Pain)

When assessing soft-tissue pathology, it can be helpful to explicitly consider tissue stiffness as part of the differential diagnosis. In plantar fasciitis (plantar heel pain), the plantar fascia can present as a high-stiffness structure, which can concentrate stress at the medial calcaneal tubercle.

In these cases, the working plan is often to reduce excessive stiffness and improve load tolerance through appropriately dosed strengthening, load modification, and progressive exposure—rather than relying only on passive stretching.

Quick Clinical Screen and Loading Focus

• Start by palpating the posterior heel and the Achilles tendon (AT) mid-portion for tenderness.
• If tenderness is palpable at the insertion: prioritise calf strengthening. Ensure the start and end point of the heel raise is clearly defined and communicated to the patient, and follow the protocol.
• Identify the point of tenderness (POT) using the relevant landmarks. If the POT is located at medial gastrocnemius, cue toes forward or slightly in during strengthening (and vice versa, depending on the location).
• If tenderness is palpable at the mid-portion AT: focus on eccentric AT loading and isometric heel holds. Cue the patient to stand tall through the entire range from the lowest position of the heel drop to the heel raise, and follow the protocol.
• If additional load is needed, add sandbags in a backpack for progressive resistance.

Monitor and Modify (Forefoot)

Monitor for symptoms of forefoot pain or discomfort during these exercises. If metatarsal heads become tender, identify the involved met heads and modify the orthosis accordingly to reduce met head loading.

Clinical Approach

A biomechanical assessment can broaden the differential diagnosis for Achilles tendon pain, plantar fascia pain, forefoot pain, midfoot pain, and even knee pain. Clinically, this means asking which tissue is overloaded, what is contributing to the overload, and how treatment can shift forces to a more tolerable range.

Core Management Strategies

• Tissue stress theory: reduce load on the irritated structure using strapping or taping, foot orthoses, footwear modification, ankle-foot orthoses, or immobilisation when indicated.
• Inflammatory management: if an inflammatory response is present, symptom relief may include paracetamol, NSAIDs, or corticosteroid therapy when appropriate.
• Strength and conditioning: progressive loading remains fundamental because it improves tissue capacity and long-term resilience.

Practical Takeaway

For podiatry patients, the best outcomes often come from combining symptom control with a clear understanding of tissue mechanics. Stiffness, elasticity, and force transmission all influence how the Achilles tendon and plantar fascia behave under load, so treatment should be matched to the specific mechanical problem rather than the pain location alone.

Ready to get help with heel pain or tendon pain?

If you’d like an individual assessment (and a clear plan you can follow), you can book an appointment online with Foot Focus Podiatry.

Book online: Foot Focus Podiatry – Online Booking

Prefer to chat first? Get in touch via the website and our team will help you choose the right appointment.