Diagnostics

Diagnosis is usually clinical.

Provocative tests such as the windlass test may be helpful in the diagnosis.

Consider imaging in diagnostic uncertainty or refractory pain.

Performing the windlass test can aid in the diagnosis of plantar fasciitis.

• The patient is asked to stand on a step stool with the toes overhanging the edge.

• The great toe is then passively dorsiflexed.

• The result is positive if pain is reproduced over the calcaneal insertion of the plantar aponeurosis.

High specificity (100%) but low sensitivity (32%) for plantar fasciitis.

Modalities

• First-line: x-ray foot (weight-bearing)

• Further studies: ultrasound, MRI

Findings are usually nonspecific; e.g:

• Bone spurs

• Plantar fascia thickening

• Edema at the insertion of the calcaneus

Skeletal [1][6]

• Calcaneal stress fracture

• Acute calcaneal fracture

Neurologic

• Tarsal tunnel syndrome

  • Entrapment of the calcaneal nerve (medial or inferior)

  • Entrapment of the plantar nerve (medial or lateral)

Soft tissue

• Achilles tendinopathy

• Heel pad syndrome

• Tenosynovitis

• Plantar fascia rupture

• Retrocalcaneal bursitis

Others

• Reactive arthritis

• Ankylosing spondylitis

• Gout

• Osteomyelitis

• Malignancy

Reduction of biomechanical stress

• Rest and activity modification

• Avoidance of nonsupportive shoes

• Consideration of external support (e.g., foot taping, orthotic insoles)

Stretching and strengthening exercises specific for the plantar fascia

Pain management, which may include:

• NSAIDS

• Corticosteroid injections