Editing Plantar fasciitis (section)

==Diagnosis==
[[File:Dorsiplantar.jpg|thumb|upright|[[Achilles tendon]] tightness is a risk factor for plantar fasciitis. It can lead to decreased [[dorsiflexion]] of the foot.]]
[[File:Projectional radiography of calcaneal spur.jpg|thumb|[[Calcaneus|Heel bone]] with heel spur (red arrow)]]
[[File:Plantarfascia.png|thumb|Thickened plantar fascia in ultrasound]]

Plantar fasciitis is usually diagnosed by a [[health care provider]] after consideration of a person's presenting history, risk factors, and clinical examination.<ref name="Goff_2011"/><ref name="Buchbinder_2014">{{cite journal | vauthors = Buchbinder R | title = Clinical practice. Plantar fasciitis | journal = The New England Journal of Medicine | volume = 350 | issue = 21 | pages = 2159–2166 | date = May 2004 | pmid = 15152061 | doi = 10.1056/NEJMcp032745 }}</ref><ref>{{cite journal | vauthors = Cole C, Seto C, Gazewood J | title = Plantar fasciitis: evidence-based review of diagnosis and therapy | journal = American Family Physician | volume = 72 | issue = 11 | pages = 2237–2242 | date = December 2005 | pmid = 16342847 | url = https://www.aafp.org/afp/2005/1201/p2237.html }}</ref> Palpation along the inner aspect of the heel bone on the sole may elicit tenderness during the physical examination.<ref name="Goff_2011"/><ref name="Molloy_2012"/> The foot may have limited [[dorsiflexion]] due to excessive tightness of the [[Triceps surae muscle|calf muscles]] or the [[Achilles tendon]].<ref name="Tahririan_2012"/> Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion.<ref name="Goff_2011"/><ref name="Monto_2013"/> Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.<ref name="Tahririan_2012"/> Occasionally, a physician may decide imaging studies (such as [[Radiography|X-rays]], [[Medical ultrasonography|diagnostic ultrasound]], or [[Magnetic resonance imaging|MRI]]) are warranted to rule out serious causes of foot pain.

Other diagnoses that are typically considered include fractures, tumors, or systemic disease if plantar fasciitis pain fails to respond appropriately to conservative medical treatments.<ref name="Goff_2011"/><ref name="Molloy_2012"/> Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Under these circumstances, diagnostic tests such as a [[complete blood count|CBC]] or serological markers of inflammation, infection, or [[autoimmune disease]] such as [[C-reactive protein]], [[erythrocyte sedimentation rate]], [[anti-nuclear antibody|anti-nuclear antibodies]], [[rheumatoid factor]], [[HLA-B27]], [[uric acid]], or [[Lyme disease]] antibodies may also be obtained.<ref name="Cutts_2012"/> Neurological deficits may prompt an investigation with [[electromyography]] to check for damage to the nerves or muscles.<ref name="Monto_2013"/>

An incidental finding associated with this condition is a [[heel spur]], a small bony [[calcification]] on the [[calcaneus]] (heel bone), which can be found in up to 50% of those with plantar fasciitis.<ref name="Tu_2011"/> In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself.<ref name="Orchard_2012"/> The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.<ref name="Monto_2013"/>

===Imaging===
Medical imaging is not routinely needed. It is expensive and does not typically change how plantar fasciitis is managed.<ref name="Yin_2014">{{cite journal | vauthors = Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, Tong ZY, Wu XQ, Ma JM, Mo W | display-authors = 6 | title = Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials | journal = Archives of Physical Medicine and Rehabilitation | volume = 95 | issue = 8 | pages = 1585–1593 | date = August 2014 | pmid = 24662810 | doi = 10.1016/j.apmr.2014.01.033 }}</ref> When the diagnosis is not clinically apparent, lateral view X-rays of the ankle are the recommended imaging modality to assess for other causes of heel pain, such as [[stress fracture]]s or bone spur development.<ref name="Tahririan_2012"/>

The plantar fascia has three fascicles-the central fascicle being the thickest at 4&nbsp;mm, the [[lateral (anatomy)|lateral]] fascicle at 2&nbsp;mm, and the [[medial (anatomy)|medial]] less than a millimeter thick.<ref>{{cite journal | vauthors = Ehrmann C, Maier M, Mengiardi B, Pfirrmann CW, Sutter R | title = Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers | journal = Radiology | volume = 272 | issue = 3 | pages = 807–814 | date = September 2014 | pmid = 24814176 | doi = 10.1148/radiol.14131410 }}</ref> In theory, plantar fasciitis becomes more likely as the plantar fascia's thickness at the calcaneal insertion increases. A thickness of more than 4.5&nbsp;mm [[ultrasound]] and 4&nbsp;mm on [[magnetic resonance imaging|MRI]] are useful for diagnosis.<ref>{{cite journal | vauthors = League AC | title = Current concepts review: plantar fasciitis | journal = Foot & Ankle International | volume = 29 | issue = 3 | pages = 358–366 | date = March 2008 | pmid = 18348838 | doi = 10.3113/fai.2008.0358 | s2cid = 6734497 }}</ref> Other imaging findings, such as thickening of the plantar aponeurosis, are nonspecific and have limited usefulness in diagnosing plantar fasciitis.<ref name="Orchard_2012"/>

[[Bone scan|Three-phase bone scan]] is a sensitive modality to detect active plantar fasciitis. Furthermore, a [[bone scan|3-phase bone scan]] can be used to monitor response to therapy, as demonstrated by decreased uptake after corticosteroid injections.<ref>{{cite journal | vauthors = Pelletier-Galarneau M, Martineau P, Gaudreault M, Pham X | title = Review of running injuries of the foot and ankle: clinical presentation and SPECT-CT imaging patterns | journal = American Journal of Nuclear Medicine and Molecular Imaging | volume = 5 | issue = 4 | pages = 305–316 | year = 2015 | pmid = 26269770 | pmc = 4529586 }}</ref>

===Differential diagnosis===
The differential diagnosis for heel pain is extensive and includes pathological entities including, but not limited to, the following: [[calcaneal fracture|calcaneal stress fracture]], [[septic arthritis]], [[Policeman's heel|calcaneal bursitis]], [[osteoarthritis]], [[spinal stenosis]] involving the nerve roots of [[lumbar spinal nerve 5|lumbar spinal nerve 5 (L5)]] or [[sacral spinal nerve 1|sacral spinal nerve 1 (S1)]], calcaneal fat pad syndrome, metastasized cancers from elsewhere in the body, [[hypothyroidism]], [[gout]], [[Seronegative spondyloarthropathy|seronegative spondyloparthopathies]] such as [[reactive arthritis]], [[ankylosing spondylitis]], or [[rheumatoid arthritis]] (more likely if pain is present in both heels),<ref name="Cutts_2012"/> plantar fascia rupture, and [[compression neuropathy|compression neuropathies]] such as [[tarsal tunnel syndrome]] or impingement of the [[Medial calcaneal branches of the tibial nerve|medial calcaneal nerve]].<ref name="Rosenbaum_2014"/><ref name="Cutts_2012"/><ref name="Tahririan_2012"/>

A determination about a diagnosis of plantar fasciitis can usually be made based on a person's medical history and physical examination.<ref name="ACOEMfive">{{Citation |author1 = American College of Occupational and Environmental Medicine |author1-link = American College of Occupational and Environmental Medicine |date = February 2014 |title = Five Things Physicians and Patients Should Question |publisher = American College of Occupational and Environmental Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-occupational-and-environmental-medicine/ |access-date = 24 February 2014 |url-status=live |archive-url = https://web.archive.org/web/20140911001813/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-occupational-and-environmental-medicine/ |archive-date = 11 September 2014 }}, which cites
* {{cite book | vauthors = Haas N, Beecher P, Easly M | veditors = Hegmann KT |title=Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers|date=2011|publisher=American College of Occupational and Environmental Medicine |chapter=Ankle and foot disorders |page=1182 |location=Elk Grove Village, IL|isbn=978-0615452272|edition=3rd|display-authors=etal}}</ref> When a physician suspects a fracture, infection, or some other serious underlying condition, they may order an X-ray to investigate.<ref name="ACOEMfive"/> X-rays are unnecessary to screen for plantar fasciitis for people who stand or walk a lot at work unless imaging is otherwise indicated.<ref name="ACOEMfive"/>