Plantar Fasciitis Symptoms and Diagnosis
Symptoms of plantar fasciitis consist of a gradual onset of pain under the heel which may radiate forwards into the foot.
Below we explain in detail the signs and symptoms of plantar fasciitis as well as the process a professional therapist would undergo in order to correctly diagnose the condition.
There may be tenderness under the sole of the foot and on the inside of the heel when pressing in. The pain can range from being slightly uncomfortable to very painful depending on how badly it is damaged.
Pain is usually worse first in the morning because the foot has been in a relaxed position all night and the plantar fascia temporarily shortens. After walking around this usually eases as the tissues warm up and gradually stretch out. When the condition is present, similar periods of moving around following inactivity such as sitting for long periods can also trigger the pain. In the early acute stages stretching the plantar fascia may also be painful.
As the injury becomes more severe the patient may experience pain all of the time, when walking or standing and may worsen with activities such as running or playing sport.
People that suffer with plantar fasciitis often present with tight calf muscles (play assessment & diagnosis video) or have very low arches of the foot (flat feet). It is not uncommon for individuals who suffer this condition to have some biomechanical issues that contribute to the problem such as 'over pronation (rolling in or flattening of the foot) or excessive supination (rolling out).
To diagnose plantar fasciitis a doctor may recommend an ultrasound scan of the foot. In addition to this an X-ray may be taken to see a heel spur (extra bone) where the fascia attaches, as this is often the location of pain. However, a heel spur can be present without pain and pain may be felt with no visible heel spur. The two are not always linked.
The video above explains how Plantar Fasciitis might be assessed and diagnosed. Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury.
The aim of these questions is to determine which structure may be causing the pain and what treatment is appropriate. The therapist will then perform several tests and assessments as described below.
Observe posture - The therapist should observe the position of the patient in both standing and walking. They should be paying particular attention to the arch of the foot, looking for fallen arches, a high arch, overpronation and oversupination.
Palpation - The therapist will usually palpate, or feel, the area, including the heel and arch of the foot. Pain on palpation of the inside of the heel or arch indicates plantar fasciitis.
Range of motion - As already discussed, a decreased range of motion at the ankle can contribute to developing plantar fasciitis. The therapist should pay particular attention to the amount of dorsiflexion (pointing the foot up towards the ceiling) as a decreased range here can indicate tight calf muscles. A normal range of motion should comfortably allow a 90 degree angle between the lower leg and foot.