Symptoms of plantar fasciitis consist of under the heel that develops gradually and may radiate forwards into the foot. Below we explain in detail the signs and symptoms of plantar fasciitis as well as describing how a professional therapist might diagnose the condition.
Symptoms of plantar fasciitis include pain under the heel and this often develops gradually and may extend towards the toes or under the arch of the foot. There is usually tenderness under the sole of the foot, especially under the heel and along the arch.
The pain can range from being slightly uncomfortable to very painful, depending on how badly it is damaged and inflamed. The pain is usually worse first in the morning, because the foot has been kept in a relaxed position overnight and the plantar fascia temporarily shortens.
As a result, when you place the foot on the ground after getting out of bed, the first few steps can be particularly painful as the inflamed/shortened plantar fascia becomes stretched. However, after a period of walking around, the pain usually eases and this is because the tissues warm up and are gradually stretched out. During the day, similar periods of inactivity (such as sitting for long periods), followed by walking, can also trigger the pain. As the injury worsens, the patient may start to experience pain all of the time, including during both walking and standing and will be worse on activities such as running or playing sport.
People who suffer with plantar fasciitis often present with tight calf muscles (see assessment & diagnosis video below) and / or may have very low arches in the feet (called over pronation or flat feet). It is not uncommon for individuals who suffer this condition to have several biomechanical issues in the pelvis, hips, knees and ankles that contribute to the problem and may require a biomechanical assessment. Footwear is also often a contributing factor and advice on the most appropriate shoes to wear for this condition may be required.
To diagnose plantar fasciitis, a doctor may recommend an ultrasound scan of the foot. The ultrasound scan is used to assess the damage to the fasica itself and assess whether further treatment, such as an injection are indicated. In addition to this, an X-ray may be requested to see if a heel spur (extra bone) has developed and can occur when the fascia pulls at the bone where it attaches to the heel and cause a traction injury resulting in a bone spur which can be very painful. However, a heel spur can also be present without pain and vice-versa - pain may be felt with no visible heel spur.
The video above explains how plantar Fasciitis might be assessed and diagnosed. Assessment of any injury will involve the therapist asking a series of questions concerning the symptoms and signs of the current injury but also about the patient’s general health and any previous to see if they are linked and may be a contributing cause. The aim of these questions is to determine which structure may be causing the pain and what treatment is then appropriate for the injury. The therapist will then perform several tests to confirm the diagnosis and these may include those described below.
Observation of Posture - The therapist may observe the posture of the patient in both standing and walking, paying particular attention to the arch of the foot, looking for fallen or low arches and conversely high arches, over pronation (foot rolled in) and possibly over supination (foot rolled out). They may also assess the position of the knee relative to the hip and ankle and the hip relative to the pelvis.
Palpation - The therapist will usually palpate (feel for) the painful area, including under the heel and along the arch of the foot. Pain on palpation in these areas is often a sign that indicates plantar fasciitis.
Range of Motion - As already discussed, a tight calf leading to a decreased range of motion at the ankle can contribute to developing plantar fasciitis. The therapist may pay particular attention to the amount of dorsiflexion (bending the ankle and pulling the toes upwards) as a reduction in range here can indicate tight calf muscles.