Physical exam for plantar fasciitis

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Doctors usually diagnose plantar fasciitis based on a medical history and a physical exam. Your doctor will check your feet for problems that affect how your feet work (biomechanical factors), such as a high arch, flat feet, abnormal gait, or tight Achilles tendon or calf muscles. Your doctor will also look for excessive tenderness and examine joint motion and looseness, muscle and tendon function, nerve function, and blood circulation.

Your doctor will do a physical exam to evaluate heel pain.

Findings of a physical exam may include the following.

Normal

In a normal exam there is no pain, tenderness, or swelling in the heel area. Structure, function, and biomechanics are normal as well.

Abnormal

Abnormal findings that may indicate plantar fasciitis include the following:

• You have pain when you take your first steps after getting out of bed or after sitting for a long period of time. Your doctor usually will discover this during a review of your medical history.
• When your doctor presses your heel, you have a characteristic tender spot deep in the tissue on the bottom of your heel where the plantar fascia attaches to the heel bone just in front of the heel pad.
• Sometimes there is tenderness in the middle of the plantar ligament or elsewhere in the plantar ligament. This pain is more common in athletes who spend a lot of time on the balls of their feet, as in aerobics, sprinting, basketball, or cycling.
• Flexing or standing on your toes causes heel pain.
• Local swelling in the bottom of the foot may be present, which may indicate more significant tearing in the plantar fascia.
• While standing, you have a high or low arch. While walking, you have excessive inward rolling of the foot (pronation) when your heel strikes the ground.
• Visible inflammation is usually not present.

Your doctor usually will start nonsurgical treatment without further testing. X-rays and lab tests usually are not necessary if the medical history and physical exam indicate plantar fasciitis and your doctor does not suspect other problems.

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