What is included in the physical exam to evaluate plantar heel pain?

Updated: Oct 01, 2018
  • Author: Vinod K Panchbhavi, MD, FACS; Chief Editor: Thomas C Dowd, MD  more...
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Answer

A general examination is necessary to rule out systemic causes of heel pain. A spine examination is required if the pain radiates or if the history is suggestive of radiculopathy.

In the local examination, inspect the foot and the heel for any abnormalities such as swelling, lumps, scars, bruising, or foot deformities such as pes planus or pes cavus.

Palpation is performed to elicit the site of maximum tenderness. Practitioners should be cognizant of the "windlass mechanism" of the plantar fascia. [16, 17] Check the condition of the fad pad, feel for defects or lumps in the plantar fascia, and identify any bony deformity due to previous fractures.

Percussion over the tibial nerve in the tarsal tunnel and its distal branches is performed to check for hypersensitivity or tingling. Percussion over any previous scars in the region can be performed to detect a neuroma in the scar.

Examining the range of motion at the ankle joint and a performing a Silfverskiöld test reveals any stiffness in the gastrocnemius and/or the triceps surae complex. [18]


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