Presenting Symptoms of Plantar Fasciitis
The hallmark presenting symptom of plantar fasciitis is sharp, stabbing heel pain on the plantar surface that is worst with the first few steps in the morning or after prolonged sitting, with point tenderness at the medial plantar calcaneal region. 1, 2
Classic Pain Pattern
The pain characteristics are highly specific and include:
- Sharp, stabbing, nonradiating pain located on the proximal medioplantar surface of the foot, specifically at the anteromedial calcaneus 2
- Post-static dyskinesia: Pain is most severe with initial weight-bearing after periods of rest, particularly the first steps upon waking in the morning 1, 3
- End-of-day worsening: Pain typically becomes worse at the end of the day after prolonged standing or activity 2
- Pain improves with initial activity but returns with continued use 4
Physical Examination Findings
The diagnosis is confirmed through specific examination findings:
- Point tenderness to palpation at the proximal plantar fascial insertion on the medial tubercle of the calcaneus—this is the most reliable diagnostic finding 2, 4
- Passive dorsiflexion test: Discomfort in the proximal plantar fascia can be elicited by passive ankle and first toe dorsiflexion 1
- Limited ankle dorsiflexion range of motion is commonly present 2
- Gastrocnemius tightness is frequently associated 4
Patient Demographics and Risk Factors
Patients typically present with:
- Middle-aged or older adults, though it affects both sedentary and athletic populations 1
- Increased body mass index (obesity) 1, 2
- History of prolonged standing or occupation-related activity 2, 5
- Excessive foot pronation or poor biomechanics 1, 5
- Runners or individuals with recent increase in activity 2
Important Clinical Caveats
A critical pitfall is that plantar fasciitis is predominantly a clinical diagnosis based on history and physical examination alone—imaging is not needed for initial diagnosis and should be reserved for atypical presentations or symptoms persisting beyond 3 months despite treatment. 1, 2 The American College of Foot and Ankle Surgeons emphasizes that diagnostic imaging is rarely needed initially. 6
The condition is self-limited in most cases, with 80-90% of patients improving within 12 months with conservative treatment, though symptoms can persist for months to years if untreated. 1, 2, 4