3 Signs of Plantar Fasciitis

Summary:

Plantar fasciitis is a condition involving pain on the bottom of the foot and heel. Pain is usually felt with the first few steps in the morning and it can be aggravated with activities like walking and running. Recognizing the signs of plantar fasciitis will help you recover faster. In this article, we will discuss the definition of plantar fasciitis, 3 signs of plantar fasciitis, and 3 tests you can do at home to check for plantar fasciitis.

What is plantar fasciitis?

 

Plantar fasciitis involves pain on the bottom of the foot usually at the insertion of the plantar fascia on the heel. It is one of the most common foot injuries that can limit your quality of life. The condition is inflammatory as indicated with the “-itis” suffix.

If the condition is not inflammatory, it is known as plantar fasciopathy or plantar fasciosis. Plantar fasciosis is a more accurate and inclusive description of pain on the bottom of the foot associated with the plantar fascia.

The plantar fascia is a band of connective tissue that attaches from the heel to the toes. The plantar fascia can usually be seen and felt along the bottom of the foot when the big toe is extended backward.

Plantar fasciitis is common. There was an incidence of approximately 1 million doctor visits per year in the United States due to plantar fasciitis.

Tests a physical therapist or doctor may use to identify plantar fasciitis:

 

  • Palpation of the proximal plantar fascia insertion
  • Active and passive talocrural joint dorsiflexion range of motion
  • The tarsal tunnel syndrome test
  • The windlass test
  • The longitudinal arch angle

 

(From the Journal of Orthopedic and Sports Physical Therapy)

Other conditions with signs similar to plantar fasciitis:

 

  • Calcaneal stress fracture
  • Bone Bruise
  • Fat pad atrophy
  • Tarsal tunnel syndrome
  • Soft-tissue, primary, or metastatic bone tumors
  • Paget disease of bone
  • Sever’s disease

 

(From the Journal of Orthopedic and Sports Physical Therapy)

I know the information above may seem overwhelming and confusing. It is best for plantar fasciitis to be diagnosed by a healthcare professional instead of self-diagnosing it.

However, I want to highlight 3 signs of plantar fasciitis you can recognize to give you more insight into your pain or injury.

Sign #1: Pain at the bottom of the heel

 

A classic sign of plantar fasciitis is a pain at the insertion of the plantar fascia on the bottom of the heel. The painful point is usually at the inner portion of the heel.

Some people may experience pain along the arch of the foot. Let’s perform a test to identify the location of your pain.

Test for Sign #1

heel pain starting crop

Starting position

Sit at the edge of a chair. Place the affected foot on top of the other knee.

heel pain ending crop

Ending position

Push your thumb into your heel at various locations to pinpoint the pain. Apply a moderate amount of pressure with your thumb.

The test is positive if you can identify a painful spot at the inner portion of the heel. Try not to jump out of your chair if you find the spot!

Sign #2: Foot pain with the first few steps in the morning

 

Another classic sign of plantar fasciitis is having pain on the bottom of the foot with the first few steps in the morning.

During the night, the plantar fascia has an opportunity to partially recover. Then, it gets immediately aggravated as it gets strained in the morning with walking.

Test for Sign #2

Step 1: Write down your level of pain before going to bed and before getting up in the morning. Use a scale of 0-10 with “10” being the worse pain imaginable and “0” being no pain.

Step 2: Write down your level of pain after taking your first few steps in the morning.

Taking notes crop

Did your level of pain increase after taking a few steps in the morning?

If so, then you are demonstrating a classic sign of plantar fasciitis.

Sign #3: Pain with the Windlass Test

The plantar fascia becomes taut causing the arch of the foot to rise when the big toe is lifted up. This is known as the Windlass mechanism.

The Windlass mechanism provides support and distributes load to the foot during weight bearing activities like walking and running.

The image to the right shows the Windlass mechanism when the toes are lifted up.

plantarfaciitis

Windlass Mechanism

Test for Sign #3

Windlass starting crop

Starting position

Sit at the edge of a chair. Place the affected foot on top of the other knee.

Windlass Ending crop

Starting position

Pull back on the big toe to extend it. Visually observe what happens to the bottom of the foot. If you do not feel pain with the big toe lifted up, then press your thumb into the heel.

The test is positive if you feel pain from lifting the big toe up or if you feel pain as you press the thumb into the heel with the big toe lifted up.

A positive Windlass test is another sign of plantar fasciitis; however, this sign alone does not conclusively mean you have plantar fasciitis.

What is the significance of these tests?

 

It can be confusing to identify the source of your pain. The source of pain is often located in another area of the body.

For example, irritation in the lower back can send pain to the bottom of your foot due to the distribution of pain signals. It is also possible to feel pain in the absence of any structural problem with the plantar fascia or foot.

I believe these 3 signs of plantar fasciitis will paint a more clear picture of your symptoms. To confirm the diagnosis of plantar fasciitis, you should consult with your doctor or physical therapist.

A skilled doctor or physical therapist can help you understand the contributing factors to your pain and develop a program to help you improve your function.

What are other signs and symptoms of plantar fasciitis?

 

  • Pain with prolonged walking or standing
  • Pain with steps after prolonged inactivity
  • No numbness or tingling in the feet
  • No signs of the lower back or nerves radiating pain to the feet

What should you do if you have these 3 signs of plantar fasciitis?

 

As mentioned above, there may be other sources of your pain. The presence of these 3 signs alone does not mean you have plantar fasciitis.

If you have these 3 signs of plantar fasciitis then you should seek medical treatment from a physical therapist. A physical therapist will assess your mobility, strength, and analyze your movements and behaviors to identify the contributing factors to your pain.

After a physical therapy assessment, you will be prescribed specific exercises to eliminate pain and get stronger. These exercises are a great option to improve your quality of life and get back to walking, hiking, and running again.

Is it easy to “fix” plantar fasciitis?

 

Think of the treatment for plantar fasciitis as a process rather than a quick fix. There are no quick fixes when recovering from injuries.

It is normal to have ups and downs during the rehab process. Many people get discouraged and give up in the middle of the process. Stay encouraged.

It is important to stay consistent with the rehab process to allow time for your body to adapt and recover. Over time, you will get better!

What are your next steps?

 

If you recognized these 3 signs of plantar fasciitis, then it is possible you might have it. If the pain does not go away, then take action to see a physical therapist.

For guidance, click here.

Watch this YouTube Video on plantar fasciitis:

 

Read these articles to learn more about plantar fasciitis:

References:

1.Heel Pain—Plantar Fasciitis. Thomas G. McPoil, et. al. Journal of Orthopaedic & Sports Physical Therapy 2008 38:4, A1-A18

2. Nahin RL. Prevalence and pharmaceutical treatment of plantar fasciitis in United States adults. Journal of Pain.March 26, 2018. Epub ahead of print.

3. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25:303–10.

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About the Author:

Dr. Marc Robinson, PT, DPT, Cert. MDT is a physical therapist based out of San Diego, California. He teaches individuals how to manage pain and injuries better using evidence-based exercise and neuroscience. His easy-to-understand approach empowers individuals to live an active life with greater freedom of movement.