Plantar Fasciitis: Evidence-Based Management

Robert D. Glatter, MD, FAAEM

Disclosures

October 10, 2007

Diagnosis

A careful history and physical examination can usually establish the diagnosis of a painful heel syndrome. Pain typically occurs with the first step in the morning and lessens with activity, although it may return with activity during the day or with certain activities such as walking up stairs. The antero-medial aspect of the plantar aponeurosis is the point of maximal tenderness in patients with a painful heel syndrome. Ankle dorsiflexion may be limited secondary to pain, and pain may be elicited through passive dorsiflexion of the toes.

Plain radiography of the ankle and foot may be useful as a screening test to exclude other etiologies including osteomyelitis or a suspected foreign body. MRI and ultrasound can identify pathologic thickening of the fascia and surrounding edema suggestive of the condition. Radionuclide scanning as well as computed tomography scans have also been used in this setting to identify unknown causes of persistent heel pain. Ancillary tests have limited value and are generally not necessary in identifying patients with plantar fasciitis

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