eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Plantar Fasciitis: Differential Diagnoses & Workup

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Contributor Information and Disclosures

Updated: Mar 31, 2008

Differential Diagnoses

Achilles Tendon Injuries and Tendonitis
Calcaneal Bursitis
Retrocalcaneal Bursitis
Tarsal Tunnel Syndrome

Other Problems to Be Considered

Acute traumatic rupture of the plantar fascia
Calcaneal neuritis
Calcaneal stress fracture
Lumbosacral radiculopathy of S1 nerve root

Workup

Laboratory Studies

  • No specific laboratory studies are needed to confirm the diagnosis of plantar fasciitis unless there is a bilateral presentation that appears in association with some seronegative spondyloarthropathies. Then the standard hematologic and chemistry studies may include, but are not limited to, a complete blood cell count, an erythrocyte sedimentation rate, complete metabolic panel, rapid plasma reagin, and rheumatoid factor study.

Imaging Studies

  • Radiographic imaging of the foot generally confirms the clinical examination and may reveal a heel spur that is the result of this condition and not a cause. The heel spur is best seen on the lateral view, located at the antero-inferior aspect of the calcaneus. Radiographic films of the foot should be obtained prior to corticosteroid injection or for any patient who continues to have symptoms despite 1-2 months of conservative, nonsurgical treatment. Standing lateral radiographs may help in the assessment for stress fractures of the calcaneus (a rare condition) in patients with pain at rest.
  • Three-phase bone scanning is helpful for patients in whom there is a suggestion of a stress fracture of the calcaneus in spite of negative findings with plain radiography. In plantar fasciitis, a bone scan often shows increased uptake over the medial calcaneal tuberosity due to the local inflammation. This should not be confused with a stress fracture that shows increased uptake elsewhere in the calcaneus.
  • If stress fracture remains a significant consideration despite negative radiographic findings, further imaging studies could include a computed tomography (CT) scan.
  • Plantar fasciitis can be identified using ultrasonography by visualizing a thickened heel aponeurosis.7,8

More on Plantar Fasciitis

Overview: Plantar Fasciitis
Differential Diagnoses & Workup: Plantar Fasciitis
Treatment & Medication: Plantar Fasciitis
Follow-up: Plantar Fasciitis
References
[ CLOSE WINDOW ]

References

  1. Brinker MR, Miller MD. Common adult conditions of the foot. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:349-58.

  2. McGee DJ. Lower leg, ankle and foot. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:448-513.

  3. Snider RK. Plantar fasciitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:464-9.

  4. Tarquinio TA. Foot. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:268-96.

  5. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.

  6. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  7. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. Dec 1 2005;72(11):2237-42. [Medline]. [Full Text].

  8. Hsu CC, Tsai WC, Chen CP, et al. Ultrasonographic examination of the normal and injured posterior cruciate ligament. J Clin Ultrasound. Jul-Aug 2005;33(6):277-82. [Medline].

  9. Radford JA, Landorf KB, Buchbinder R, et al. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. Apr 19 2007;8:36. [Medline]. [Full Text].

  10. Flanigan RM, Nawoczenski DA, Chen L, et al. The influence of foot position on stretching of the plantar fascia. Foot Ankle Int. Jul 2007;28(7):815-22. [Medline].

  11. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. May 2007;28(5):549-56. [Medline].

  12. Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.

  13. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. Sep 2007;28(9):984-90. [Medline].

  14. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. May 2005;15(3):119-24. [Medline].

  15. Govindarajan R, Bakalova T, Doss NW, et al. Posterior tibial nerve block in the therapeutic management of painful calcaneal spur (plantar fasciitis): a preliminary experience. Can J Anaesth. Oct 2003;50(8):862-3. [Medline]. [Full Text].

  16. Kane D, Greaney T, Bresnihan B, et al. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. Jun 1998;57(6):383-4. [Medline]. [Full Text].

  17. Tsai WC, Wang CL, Tang FT, et al. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. Oct 2000;81(10):1416-21. [Medline].

  18. Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle Int. Apr 2002;23(4):301-8. [Medline].

  19. Babcock MS, Foster L, Pasquina P, et al. Treatment of pain attributed to plantar fasciitis with botulinum toxin A: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. Sep 2005;84(9):649-54. [Medline].

  20. Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg. Mar-Apr 2007;46(2):75-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

heel pain syndrome, plantar heel pain, proximal plantar fasciitis, subcalcaneal pain, orthotic arch support, shoe insert, heel pad, fat pad, heel spur, exostosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Everett C Hills, MD, MS, Medical Director, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Assistant Professor of Neurology, Penn State Milton S. Hershey Medical Center and Penn State University College of Medicine
Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.