The main symptom of plantar fasciitis is pain under the heel which has developed gradually and may radiate forwards into the arch of the foot. Here we explain how a professional therapist may use a range of techniques to help diagnose plantar fasciitis.
This will include an initial consultation, patient history, looking for any signs and symptoms, observing the posture and gait as well as a physical examination to assess flexibility and palpating or feeling the tissues in the foot. Imaging such as X-ray or MRI may also be used if available.
A thorough assessment will begin by taking a case history to try and identify when the injury occurred or how long it has been present for. Most people will not seek medical advice until they have suffered for some time and the injury has become chronic. 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.
Signs and symptoms
The most common symptom of plantar fasciitis is pain under the heel, sometimes radiating into the arch. Pain is worst first thing in the morning or after a period of rest.
People who suffer from plantar fasciitis will often have tight calf muscles and may have very low arches in the feet (called overpronation 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 more thorough biomechanical assessment. The patient's footwear is also often a contributing factor and advice on the most appropriate shoes to wear for this condition may be required.
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, overpronation (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 of the foot - they will press into the tissue under the heel and along the arch of the foot to feel for any tension, especially when compared to the uninjured foot. If pain is triggered or reproduced then this is often a sign that indicates plantar fasciitis. This will pinpoint the exact site of the injury which is usually just under the front, inside edge of the heel bone (calcaneus).
Flexibility of the plantar fascia and calf muscles, in particular, is assessed. The plantar fascia is likely to be tight in a case of plantar fasciitis and one way of checking this is to compare it to the uninjured foot. The therapist may pay particular attention to the amount of dorsiflexion (bending the ankle and pulling the toes upwards) as reduced range of motion here can indicate tight calf muscles. The flexibility of the calf muscles is also an important aspect as tight calf muscles affect foot biomechanics and flexibility of the arch.
To help diagnose plantar fasciitis, a doctor may recommend an ultrasound scan of the foot. The ultrasound scan is used to assess the damage to the fascia itself and assess whether further treatment, such as an injection is indicated. In addition to this, an X-ray may be requested to see if a heel spur has developed. This is a tiny bone growth at the point where the fascia tissue originates on the calcaneaus and can occur when the fascia repeatedly pulls at the bone causing a traction injury. However, a heel spur can also be present without pain and vice-versa, pain may be felt with no visible heel spur growth.
Plantar fasciitis symptom checklist