Diagnosing Plantar Fasciitis

By far the most common cause of heel pain is plantar fasciitis. This condition occurs when the major ligament on the bottom of the foot, the plantar fascia, becomes inflamed and painful. Usually, a person develops symptoms when he/she increases their activity level in some way over a short period of time. Wearing shoes with poor arch support, and walking on hard surfaces are also factors in developing plantar fasciitis.The pain from plantar fasciitis is normally localized on the bottom of the heel. Patients describe the pain as being moderate to severe in most cases. You'll find that if you have plantar fasciitis that the pain will most likely not be the same throughout the day. When I hear a patient say that their worst pain of the day is when the first get up out of bed in the morning, or upon standing after prolonged periods of sitting, I put plantar fasciitis on the top of my list for their cause of heel pain.The diagnosis is made from the patient's history, the examination, and usually x-rays. When a person has had plantar fasciitis for a long period of time, it's not uncommon for a heel spur to form on the bottom of the heel bone (calcaneus). This spur forms when the plantar fascia exerts excessive tension on the bone, and new bone is therefore formed, looking like a hook. As menacing as the spur can look, this is usually not the cause of the pain. Many people who have heel spurs do not have pain, and many people with plantar fasciitis do not have heel spurs. I feel the best way to accurately make a definitive diagnosis is the use of diagnostic ultrasound. Unlike x-rays which do a poor job of seeing soft tissue (such as the plantar fascia), diagnostic ultrasound sees the plantar fascia very easily. When plantar fasciitis is present, the plantar fascia will be thicker, especially near its attachment to the heel bone. If only one foot is symptomatic, patients themselves can easily see on the diagnostic ultrasound the difference between normal and abnormal plantar fascia. The other advantages to using diagnostic ultrasound include that it's available in office, is safe, and does not take a long time to perform.Once a definitive diagnosis of plantar fasciitis is obtained, treatment can begin. On upcoming posts, I will discuss the various treatments that are available for plantar fasciitis.