Plantar Fasciitis Series
Part 3 Other Causes & Assessment of Plantar Fasciitis
Let’s look at other causes of heel pain:
Calcaneal stress fracture – localized heel pain that worsens with activity.
Calcaneal fat pad irritation – pain directly under the heel due to thinning or inflammation of the fat pad.
Intrinsic foot muscle strain – overuse or injury of small foot muscles causing plantar pain.
Idiopathic Cavus foot pain – discomfort from abnormal high-arched foot structure.
Peripheral Nerve Entrapment – compression of nerves causing burning or tingling pain.
Tarsal Tunnel Syndrome – entrapment of the posterior tibial nerve near the ankle.
Reiter’s Syndrome (Reactive Arthritis) – heel pain linked to systemic inflammation.
Rheumatoid Arthritis – autoimmune joint inflammation that may affect the heel.
Plantar Fibromas – benign fibrous nodules within the Plantar Fascia.
Clinical Assessment
Plantar Fasciitis typically causes pain at the antero-medial heel/subcalcaneal region (area of highest stress on the Plantar Fascia). The diagnosis is primarily clinical, a detailed history helps rule out other causes of heel pain, while helping find biomechanical or environmental factors. Ultrasound or MRI may confirm tissue degeneration or structural changes.
Biomechanical tests:
- Palpation (NWB): Pain localized at the medial tubercle of the calcaneus indicates Plantar Fascia involvement.
- Toe Dorsiflexion Test or Windlass Test (NWB): Passive toe dorsiflexion increases Fascia tension; palpate along the Fascia Bands for pain or nodules.
- Ankle Dorsiflexion Assessment: In STJ Neutral, less than 10° of dorsiflexion is clinically significant. Check gastrocnemius and soleus for tightness or contracture.
- Closed Chain & Gait Analysis: Evaluate for excessive pronation or supination (both increase Plantar Fascia strain.
- Gait Symmetry & LLD: Identify asymmetrical gait for leg length discrepancy (LLD) and assess limb length if suspected.
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