Diagnosis of Plantar Fasciitis

Plantar fasciitis is often diagnosed by history of the disease process. Most patients note heel pain or arch pain upon arising after rest. Often, the harder they have used their feet the day before, the more tender the heel will be upon arising the next day.

The examiner also looks at the "mechanics" of the foot, watching the patient walk. Individuals with plantar fasciitis often have feet that roll in (pronate) too much. Such feet often flatten too much with weight bearing pressure, placing tension on the plantar fascia. That can happen to an individual with a high arch, low arch or a medium arch. One does not have to be flat footed to have heel pain.

Sonography involves the use of diagnostic ultrasound to look at the fascia itself. Remember that the fascia is a ligament so it does not show up on x-rays. X-rays can be helpful to rule out things like stress fractures, arthritis, tumors but does not show the fascia. Sometimes calcium will deposit itself along the origin of the fascia, especially when the fascia has been inflamed for a long time. Since x-rays are two dimensional representations of a three dimensional object, one can see, from the side, a shelf of calcified ligament which is termed, somewhat mistakenly, a heel spur. Heel spurs, in actuality, do not exist but are simply a side view of the plantar fascia, showing a shelf of calcified ligament. The so-called spur always points forward in the tdirection of the ligament and is not the sources of the pain.

MRI's or ultrasound machines (Sonography) actually allows one to look at the plantar fascia itself studying the orientation of the fibers in the fascia and how thick they are. Sonography can be done, usually in the doctors' office on the initial visit and costs about 1/8 the price of an MRI. The average thickness of the fascia as measured by ultrasound is about 3.5 mm. a thicker fascia can be indicative of a diseased, overstressed fascia. The sonographer also looks at the orientation of the fibers which should be parallel and neat. If the fibers are running in various directions or if one sees swelling (dark areas) in the fascia, that can indicate a bad or diseased plantar fascia

Role of weight, occupation, time on feet. The more weight one has on their feet, the more tension is placed on the plantar fascia. That is true whether one is overweight or has an occupation which involves standing for long hours on hard surfaces.

People's occupation often cannot be readily modified but your doctor can order light or modified duty. Additionally, a doctor can do something as simple as writing a note to an employer requesting use of preferred shoegear. Preferred shoegear may include shoes with a lot of cushioning and support, running shoes like the New Balance 1122, New Balance 925 (the all black or all white version of the 1122), the Brooks Beast or the Brooks Addiction 6 (the all black or white leather version AKA the Addiction Leather). Use of the right prescription orhtotic in the shoe can render a shoe to become therapeutic in the standing process.

Body weight is a tougher subject. Nevertheless, if you have heels that are sore enough to make it tough to get through the day, then it may be hard to do certain exercise as walking. Keep in mind that almost all exercises can be done in an aerobic (fat burning) fashion when using lighter reps but higher frequency.