Plantar Fasciitis Assessment & Diagnosis

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.

The main symptom of plantar fasciitis is pain under the heel which develops gradually and may extend forwards 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.

A professional therapist or doctor will use a range of techniques to help diagnose plantar fasciitis including palpating or feeling the tissues in the foot, observing the posture and gait of the patient as well as imaging such as MRI if available.

Signs

People who suffer from plantar fasciitis often present with tight calf muscles (see assessment & diagnosis video below) and/or 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 biomechanical assessment. Footwear is also often a contributing factor and advice on the most appropriate shoes to wear for this condition may be required.

Imaging

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 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 (extra bone) has developed and can occur when the fascia pulls at the bone where it attaches to the heel and causes 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.

Assessment

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, 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 - 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.

The 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.

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