Pathognomonic for this condition is heel pain that is worst with the first step out of bed in the morning. In severe cases, the pain is sharp and can radiate proximally with an electric-like sensation. During the course of the day, the pain typically decreases with activity only to be re-aggravated after prolonged sitting, standing, or walking long distances. Any sudden changes in weight, exercise, running terrain, or mileage should also be noted. On physical examination, some swelling about the heel in the absence of erythema or warmth may be noted. Other findings may include the following:
1. Palpated taut and tender muscle structures about the arch may also be palpated.
2. Decreased active ankle dorsiflexion of less than 20° may indicate a tight gastroc-soleus complex.
3. Decreased hallux dorsiflexion.
4. Palpable granuloma along the medial fascial origin.
5. A positive windlass test, heel pain reproduced with passive dorsiflexion of the toes, can be elicited. According to De Gareau, performing this test while the patient is weight bearing increases its sensitivity from 13.5 to 31.8%.
6. Heel raises or toe-walking may also reproduce pain.
Shoe wear and gait patterns also supplement the overall biomechanical assessment. Much information can be gained from observing the patient's gait with and without shoes. In-toe walking with or without "kissing patellae" may indicate internal tibial torsion or excessive femoral anteversion. Studying the wear pattern on the soles of their shoes and knowing the terrain they frequent may reveal subtleties that further direct physical exam. For example, a treadmill runner whose shoes are more worn in the anteromedial aspect of the sole may have forefoot pronation. On the other hand, a lateral sole wear pattern may be caused by a rigid pes cavus. A proper shoe evaluation should examine cushioning properties of the shoe, wear pattern, manufacturing quality, and hind-foot stability.
Was this article helpful?