eMedicine Specialties > Sports Medicine > Foot and Ankle

Plantar Fasciitis: Differential Diagnoses & Workup

Author: Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Jan 18, 2008

Differential Diagnoses

Contusions
Lumbosacral Radiculopathy

Other Problems to Be Considered

Abductor digiti quinti nerve entrapment, tarsal tunnel syndrome)
Calcaneal apophysitis (Sever disease)
Calcaneal stress fracture
Calcaneus bone injuries
Entrapment syndromes (eg, medial calcaneal branch of the posterior tibial nerve entrapment, abductor digiti quinti nerve entrapment, tarsal tunnel syndrome)
Fat pad syndrome (atrophy, heel bruise)
Infection
Osteomalacia
Plantar fascia rupture
Reiter syndrome
Tendinitis (eg, of the flexor hallucis longus, flexor hallucis brevis, peroneus longus, tibialis posterior)
Tumor

Related eMedicine topics:
Ankylosing Spondylitis [in the Neurology section]
Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy [in the Rheumatology section]
Disorders of Bone Mineralization 
Gout and Pseudogout  [in the Emergency Medicine section]
Gout [in the Rheumatology section]
Nerve Entrapment Syndromes
Osteomalacia and Renal Osteodystrophy 
Paget Disease 
Rheumatoid Arthritis 
Rickets 
Tarsal Tunnel Syndrome

Workup

Laboratory Studies

  • Usually, laboratory studies are not needed in the workup of plantar fasciitis.

Imaging Studies

  • Usually, radiographs are not necessary for the physician to diagnose plantar fasciitis. However, to rule out a bony tumor or fracture, always consider obtaining at least a plain radiograph before administering a corticosteroid injection.
    • A heel spur is found in 15-25% of asymptomatic individuals in the general population; however, many patients with plantar fasciitis have no heel spur.
  • Reserve magnetic resonance imaging (MRI) or diagnostic ultrasound for the rare cases in which imaging studies are needed to confirm plantar fasciitis or partial and complete plantar fascia rupture.
  • Bone scans are useful to evaluate for stress fractures, tumors, and infection.

Other Tests

  • Electromyographic (EMG) studies are useful to evaluate for possible neurologic entrapment syndromes.

Procedures

  • Usually, no special procedures are needed for plantar fasciitis.

More on Plantar Fasciitis

Overview: Plantar Fasciitis
Differential Diagnoses & Workup: Plantar Fasciitis
Treatment & Medication: Plantar Fasciitis
Follow-up: Plantar Fasciitis
Multimedia: Plantar Fasciitis
References
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References

  1. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. Jul 19 1997;315(7101):172-5. [Medline]. [Full Text].

  2. Moseley JB Jr, Chimenti BT. Foot and ankle injuries in the professional athlete. In: Baxter DE, ed. The Foot and Ankle in Sport. St. Louis, Mo: Mosby-Year Book; 1995:321-8.

  3. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. May 2003;85-A(5):872-7. [Medline].

  4. Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech. 1980;13(5):397-406. [Medline].

  5. Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. Feb 1 2001;63(3):467-74, 477-8. [Medline]. [Full Text].

  6. De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. Mar 2003;24(3):251-5. [Medline].

  7. Reid DC. Running: injury patterns and prevention. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992:1131-58.

  8. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. Jul 2003;85-A(7):1270-7. [Medline].

  9. Gudeman SD, Eisele SA, Heidt RS Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med. May-Jun 1997;25(3):312-6. [Medline].

  10. Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:3-8.

  11. Ogden JA, Cross GL, Williams SS. Bilateral chronic proximal plantar fasciopathy: treatment with electrohydraulic orthotripsy. Foot Ankle Int. May 2004;25(5):298-302. [Medline].

  12. Ogden JA, Alvarez RG, Levitt RL, Johnson JE, Marlow ME. Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis. J Bone Joint Surg Am. Oct 2004;86-A(10):2216-28. [Medline].

  13. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med. Mar-Apr 2003;31(2):268-75. [Medline].

  14. Speed CA, Nichols D, Wies J, et al. Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial. J Orthop Res. Sep 2003;21(5):937-40. [Medline].

  15. Hammer DS, Adam F, Kreutz A, Kohn D, Seil R. Extracorporeal shock wave therapy (ESWT) in patients with chronic proximal plantar fasciitis: a 2-year follow-up. Foot Ankle Int. Nov 2003;24(11):823-8. [Medline].

  16. Theodore GH, Buch M, Amendola A, et al. Extracorporeal shock wave therapy for the treatment of plantar fasciitis. Foot Ankle Int. May 2004;25(5):290-7. [Medline].

  17. Mehra A, Zaman T, Jenkin AI. The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis. Surgeon. Oct 2003;1(5):290-2. [Medline].

  18. Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. Apr 1998;17(2):375-92. [Medline].

  19. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. Mar 1994;15(3):97-102. [Medline].

  20. Daly PJ, Kitaoka HB, Chao EY. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Foot Ankle. May 1992;13(4):188-95. [Medline].

  21. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciitis. Foot Ankle. Dec 1986;7(3):156-61. [Medline].

  22. Benton-Weil W, Borrelli AH, Weil LS Jr, Weil LS Sr. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg. Jul-Aug 1998;37(4):269-72. [Medline].

  23. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. J Foot Ankle Surg. May-Jun 1997;36(3):215-9; discussion 256. [Medline].

  24. Boyle RA, Slater GL. Endoscopic plantar fascia release: a case series. Foot Ankle Int. Feb 2003;24(2):176-9. [Medline].

  25. Conflitti JM, Tarquinio TA. Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Foot Ankle Int. Jul 2004;25(7):482-7. [Medline].

  26. Jerosch J, Schunck J, Liebsch D, Filler T. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surg Sports Traumatol Arthrosc. Sep 2004;12(5):471-7. [Medline].

  27. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. Feb 1998;19(2):91-7. [Medline].

  28. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. Jul 1994;15(7):376-81. [Medline].

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

  30. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am. Jul 1975;57(5):672-3. [Medline].

  31. Martin RP. Autologous blood injection for plantar fasciitis: a retrospective study. Paper presented at: Annual meeting of the American Medical Society for Sports Medicine; April 16-20, 2005; Austin, Texas. Clin J Sport Med. Sept 2005;15:387-8.

  32. Kiter E, Celikbas E, Akkaya S, Demirkan F, Kiliç BA. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. Jul-Aug 2006;96(4):293-6. [Medline].

  33. 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].

  34. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med. Jul 1996;6(3):158-62. [Medline].

  35. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle. Dec 1991;12(3):135-7. [Medline].

  36. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int. Jan 1998;19(1):10-8. [Medline].

  37. Mizel MS, Marymont JV, Trepman E. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. Dec 1996;17(12):732-5. [Medline].

  38. Berlet GC, Anderson RB, Davis H, Kiebzak GM. A prospective trial of night splinting in the treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion Dynasplint. Orthopedics. Nov 2002;25(11):1273-5. [Medline].

  39. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. Aug 1998;88(8):375-80. [Medline].

  40. Kwong PK, Kay D, Voner RT, White MW. Plantar fasciitis. Mechanics and pathomechanics of treatment. Clin Sports Med. Jan 1988;7(1):119-26. [Medline].

  41. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Nov 2 1998;105(5A):3S-9S. [Medline].

  42. Pfenninger JL. Joint and soft tissue aspiration and injection. In: Pfenninger JL, Fowler GC, eds. Procedures for Primary Care Physicians. St. Louis, Mo: Mosby-Year Book; 1994:1036-54.

  43. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. Dec 1998;19(12):803-11. [Medline].

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Further Reading

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Keywords

heel spurs, heel pain, inflammation of the plantar fascia, calcaneal pain

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Contributor Information and Disclosures

Author

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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