Plantar fasciitis; tips for assessment
Plantar fasciitis is a common pathology seen in our clinic and can be a challenging pathology to treat. A thorough assessment of the patient can help determine which treatment is best suited to provide optimal outcomes.
Other pathologies which can masquerade as plantar fasciitis that should not be overlooked are: plantar adventitial bursitis, medial plantar nerve entrapment, tarsal tunnel syndrome and fat pad atrophy.
When determining if it could be plantar fasciitis, remember that true plantar fasciitis pain is as the name suggests “Plantar” to the heel and has that first step pain when getting up from rest but eases as the patient gets moving.
Pain under the heel that does not improve with walking but becomes worse could actually be an adventitial bursa that is undergoing continual compression under the calcaneus.
Other pain such as on the medial aspect of the heel could be medial plantar nerve entrapment and this can be determined by simply running the wood end of a cotton bud over the plantar aspect of the affected heel and the unaffected heel. If there is more sensitivity to the unaffected heel then there is an element of medial plantar nerve entrapment.
Pain that is also related to tingling into the 1st toe may be related to tarsal tunnel entrapment of the tibial nerve which can sometimes be mistaken for plantar fasciitis.
Finally check the amount of fatty fibro padding, mostly in elderly patients or following a traumatic injury that can severely limit the heels ability to attenuate shock transmitted to it and hence cause pain in the heel area.
We always try to arrive at the most accurate diagnosis before treating this pathology and approximately 80% of patients respond well to a combination of conservative care.