An Introduction to Plantar Fasciitis Diagnosis
Plantar fasciitis is a leading cause of heel pain in patients of all ages. One of the main reasons people visit the sports podiatrist is for a correct diagnosis and accurate evaluation of their plantar fasciitis. In many cases, diagnosing the patient’s plantar fasciitis is straightforward, however in some cases there are other conditions that need to be ruled out. This might happen in situations where the patient has multiple other symptoms or foot-associated injuries which can confound judgement. The efficacy of the treatment approach entirely depends on an accurate diagnosis and assessment of the patient’s plantar fasciitis. For this reason, it is important to consult an experienced sports podiatrist for an expert evaluation of plantar fasciitis.
Anatomy and Pathophysiology of Plantar Fasciitis Diagnosis
A thorough understanding of the anatomy and biomechanics of the lower leg and foot are important when confirming a plantar fasciitis diagnosis and assessing the severity of the condition. The plantar fascia is a very strong ligament runs along the arch of the foot and connects the bottom of the heel bone to the bone at the base of the toes. The function of the plantar fascia is to support the arch of the foot and distribute forces when the person walks.
Plantar fasciitis occurs when the plantar fascia ligament becomes injured or inflamed. This generally occurs with repetitive strain or overuse, which can be the result of several factors. Inflammation is the body’s natural response to injury and strain in an attempt to repair the damaged tissues. When plantar fasciitis develops, the plantar fascia becomes thickened. If the condition is left untreated, over time the issue becomes chronic and degenerative, which can lead to the breakdown of the connective tissue in the ligament and the formation of heel spurs.
Plantar Fasciitis Diagnosis by the Sports Podiatrist
The sports podiatrist will conduct a thorough examination in order to confirm the plantar fasciitis diagnosis. Their assessment will allow them to exclude any differential diagnoses, so that the patient is sure to receive the most correct and effective treatment for their condition.
When considering a plantar fasciitis diagnosis, the podiatrist will firstly be looking for plantar heel pain that is possibly described as sharp, stabbing or burning. The pain is typically at its worst first thing in the morning when the person takes their first steps out of bed, then subsides after a few minutes of walking, as the feet begin to warm up. The pain is also usually bad after a period of rest or prolonged sitting or standing.
During the consultation and diagnostic process, the sports podiatrist will consider whether the patient has any of risk factors that are associated with plantar fasciitis. Some of these risk factors include:
- The patient’s gender, with females being at greater risk than males
- The patient’s age, with risk of developing plantar fasciitis increasing with age
- The patient’s BMI, with overweight and obese people being at greater risk
- The patient’s occupation; people in jobs that involve standing for long periods of time are at greater risk of developing plantar fasciitis
- Any physical activity that the patient participates in; runners are at increased risk.
Biomechanical Assessment and Gait Analysis in Plantar Fasciitis Diagnosis
As part of their assessment for plantar fasciitis, the sports podiatrist will most likely conduct an in-house biomechanical assessment and gait analysis. This is a particularly useful diagnostic tool, as it allows the sports podiatrist to accurately identify any imbalances, abnormalities or malalignments that may be putting pressure or strain on the plantar fascia as the person walks or runs, contributing to the development of plantar fasciitis and other conditions. In order to conduct the assessment, removable markers are placed on landmarks on the patient’s lower leg, ankle and foot. The patient walks or runs on the treadmill, as instructed, whilst a camera records footage of their leg and foot movement. The footage is then replayed in slow motion and analyzed by the sports podiatrist. Range of motion of the ankle and the height of the foot arch are also measured, as tight calf muscles, high arches and flat feet are also risk factors for the development of plantar fasciitis.
The Role of Medical Imaging in Plantar Fasciitis Diagnosis
Medical imaging is not normally necessary when diagnosing plantar fasciitis, except in certain cases where perhaps alternative conditions need to be excluded, or in cases where the patient has had persistent pain for many months and conservative treatments have not been successful. In such cases, MRI, ultrasound or xray may be indicated.
Treatment Following Plantar Fasciitis Diagnosis
Once your sports podiatrist has made a plantar fasciitis diagnosis and assessed the severity of the condition, an individualized treatment plan can be implemented. Treatment schedules and methods vary from patient to patient, and will depend entirely on individual patient factors, including lifestyle and participation in physical activity. Treatment plans are generally multi-factorial, combining a few methods of treatment for the most effective recovery. Just some of these treatments may include: resting to reduce inflammation, custom-made orthotic inserts to correctly support the arches of the feet, modifying footwear to be appropriate for the patient’s foot biomechanics, stretching the calf muscles to relieve pressure on the plantar fascia, and extracorporeal shockwave therapy, which promotes healing and tissue regeneration. Your sports podiatrist will advise you which treatments are appropriate for your condition.
Please note that the information provided in the article above regarding the diagnosis and evaluation of plantar fasciitis is intended for educational purposes only. It should not be taken as general medical advice. If you have heel pain or suspect that you might have plantar fasciitis, you should make an appointment with a suitably qualified sports podiatrist, who can provide a sound diagnosis and assessment. Appointments can be made online at https://www.sydneyheelpain.com.au/book-online/ or by phoning (02) 93883322.
Written by Karl Lockett