Houston podiatrist discusses the diagnosis of plantar fasciitisIn my last video, I discussed what plantar fasciitis is, what it's caused by and what a heel spur is. Plantar fasciitis is one of the most common conditions I see in my Houston podiatry office. It's the primary cause of heel and arch pain. And if you're watching this and you don't have it, then I'm guessing someone you know does. In today's video, I'm going to discuss how I diagnose plantar fasciitis, what tests I'll need to diagnose plantar fascia properly, and what some alternatives could be, if it turns out that your heel pain is not caused by plantar fasciitis. Welcome, I'm Houston podiatrist, Dr. Andrew Schneider

The primary way that I diagnose plantar fasciitis is clinical. I take a good history and I listen to you to find out when the pain is the worst. Most people tell me the pain is worse first thing in the morning when they step out of bed. And then, then if they sit for a period of time and get up from sitting, it hurts again. Sometimes the pain as you warm up and walk around, goes away. And sometimes it lingers. What some people say is that wearing a shoe that has less support and walking on hard surfaces will make the pain worse. While people who wear shoes that are more supportive are going to feel less pain. I also am going to examine you and I'm going to be able to pinpoint the areas that have pain when I press on certain areas of your foot. 

Aside from the clinical exam, I have to really do my due diligence because it may look like plantar fasciitis, it may sound like plantar fasciitis, but there are still some other causes of heel pain that I need to rule out.  For instance, a stress fracture. So I'm always going to take an x-ray. We have digital x-ray here in the office where I'm able to find the smallest crack in the bone. It's very high resolution. So I can look for a stress fracture. I can look for arthritis. Of course, I'll see a heel spur or anything else that's affecting the bone.

Sometimes I need to look at the soft tissue. And for that I'll use diagnostic ultrasound. Diagnostic ultrasound is a similar technology that helps you see a baby while he's still in the womb.  What it lets me do is look at the soft tissue. So I'm able to image the plantar fascia and see if it's inflamed, it looks like it's thickened on the ultrasound. And I'm able to better diagnose plantar fasciitis with the use of diagnostic ultrasound. I also may use diagnostic ultrasound if I'm giving you an injection so I can properly place that injection. but that's for another video.

If we've been treating you for awhile and you still have pain, you may need more advanced imaging. And I may send you for an MRI. An MRI will allow me to look at cross sections of your bone and soft tissue in much greater specificity. It's able to detect injuries much clearer than simple x-ray or  diagnostic ultrasound. Now, some people are anxious about MRIs because you have to slide into one of these small tubes, but typically that's not an issue for us. We'll either use an open MRI where you're not closed in, or they'll put you into the MRI feet first, so your head's going to be outside of the machine. But the results of the MRI are very important and they're going to help guide us towards our future treatment.

I appreciate you watching this video. In next week's video, we will discuss how plantar fasciitis is treated with conservative care. If this video provided value for you, please like comment, subscribe, and share it on social media. That will help others with plantar fasciitis or other foot injuries find the help that they need. And if you identify with anything we discussed today, feel free to contact us at the office and we'll schedule an immediate appointment. Thanks so much for watching and have a great day. 

Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.