Plantar Fasciitis Algorithm

Katie Barta
Michael DeDonder
Brenda Hozie
Shannon Lynch
Kelci McFarland
• Plantar fascia
• The plantar fascia is a
thick band of connective
tissue that supports the
arches of the foot. It
absorbs the ground
reaction forces from
weight-bearing activities
and distributes them
throughout the foot.
• Definition and Mechanism of Injury
• Plantar fasciitis is a condition which causes heel pain. Individuals can
acquire such pain from a sudden increase in activity, an increase in
standing or being in a weight-bearing position for a long period of time,
and/or a change in the biomechanics of the foot and subtalar joint. The
diagnosis is usually related to more of a repetitive stress to the plantar
fascia rather than an acute trauma. This repetitive stress causes an
inflammatory process of the fascia leading to pain during ambulation.
• Biomechanics/Anatomy
Rearfoot valgus
High plantar arches
Increased longitudinal medial plantar arches
Ankle equinous – leads to pronation of rearfoot and midfoot; straining of the
plantar fascia
Forefoot varus – leads to pronation of rearfoot and midfoot; straining of the
plantar fascia
Rearfoot varus – leads to rapid and excessive pronation of STJ right after
initial contact; causes strain on plantar fascia
Pes Plano Valgus– leads to rapid and excessive pronation of STJ right after
initial contact; causes strain on plantar fascia
Pes cavus – leads to each foot striking ground more often; limited pronation
of STJ limits pes cavus from absorbing GRF
• Age (over 40 yrs)
• Injury to the plantar fascia from
cumulative stress overload
• Occupational
construction workers
• Sports Related
• repetitive strain injury (long
distance runners)
• beginning new running program
• rapid increase in length or levels
of activity
• Obese (BMI greater than 30)
• Sedentary
• Limited ankle dorsiflexion or
decreased calf muscle
• Flat foot (over pronation)
• High plantar arches
• Poor biomechanics (previously
discussed) or structural
• Improper shoe selection
• How do these reflect which path we choose to take?
• When considering different causes of heel pain activity level, type of
activity and in some cases age will be a factor. Biomechanics can also be
a contributing factor to plantar fasciitis, but should also be considered for
other diagnoses such as Achilles tendinopathy, bursitis, or nerve
• Pain on medial undersurface of the heel
• Pain in the morning when stepping out of bed and taking first steps
of the day
• Stabbing pain
• Sensation of tightness and/or tenderness along arch of foot
• Pain with prolonged standing
• Pain when standing up after sitting for a long period of time
• Pain after an intense weight-bearing activity such as running
• Pain when climbing stairs
• Pain when walking barefoot or in shoes with poor support
• Symptoms may decrease during the day as the body warms up, but
will worsen again at the end of the day due to extended walking.
• Plantar fasciitis does not have a
specific test that can rule in the
diagnosis. The following list,
along with signs, symptoms, and
mechanism of injury, can lead to
the conclusion of plantar
fasciitis diagnosis versus some
other diagnosis.
• Positive tender to palpation
• Positive dorsiflexion, toe
extension PROM reproduction
of pain
• Potential change in navicular
drop test – biomechanical
• Negative radiographs
• Negative Morton’s neuroma test
• Negative Thomas test
• Negative neural test
• Limited ankle ROM
• Abnormal foot 4 points of
Heel Pain
Neural Pain
Not Plantar fasciitis
Not plantar fasciitis
Sharp ache
Location of pain
Not plantar fasciitis
Not plantar fasciitis
No increased pain
with weight-bearing
Increased pain with
Cancer – Refer out
Not plantar fasciitis
Pain at initial
Plantar fasciitis: Including pain with passive toe
extension, limited ankle dorsiflexion
Pain with prolonged
Calcaneal stress fracture
• The best way to diagnosis plantar fasciitis is to determine the
location and type of pain the patient is experiencing. Once
those are considered the algorithm can be used to rule in/out
plantar fasciitis. Remember, however, to use all of the subjective
and objective findings to aid in the diagnosis of plantar fasciitis
versus other foot/ankle pathologies.
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