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Saturday, October 8, 2011

Plantar Fascial Tears: Diagnostic Methods

Email sent October 7th, 2011 regarding post on plantar fascial tears under the heel.
http://www.drblakeshealingsole.com/2010/12/plantar-fascial-tear-possible-cause-of.html

very informative. gr8 job. i do have a question, however, if the only method of diagnosis available is x-ray, would this be enough to form a diagnosis? what other methods of diagnosis do u suggest or clinical measures to take?


lizzy, medical student


Here a Plantar Fascial Tear is noted at the attachment into the heel on an MRI. See the disruption of the normal fibres in the area.
Lizzy, Thank you for your great question. MRI is the best in my hands, but ultrasonography probably is also good (just no experience). Xray only shows bones clearly, but I do know that there is a way to highlight soft tissue better on xray (again no experience). When you pull up on the big toe, many patients have a bowstringing of the plantar fascia where it pops out under the arch. If there is a difference between the 2 sides, with less or no bowstringing on the injured side, that would be a great clue that a tear has occurred. The history of over-loading the front of the foot with the heel suspended or non-supported (like a negative heel stretch with calf raise or jump rope routine) when the pain developed is also a good clue.

A negative heel stretch (where the heel drops below the plane of the front of the foot) or prolonged non-weightbearing of the heel (like with jump rope) can produce plantar fascial tearing.
 Pain with plantar fasciitis is very gradual onset, with a tear the pain has a sudden onset. The 3 most common conditions on the bottom of the heel that cause swelling are: calcaneal fracture (gross or stress fractures), plantar fascial tear, and plantar heel bursitis. See the following video that talks more about differentiating fracture, fasciits, and bursitis (but it may help you begin to know the difference). I sure hope this helps some. Unfortunately, there are false positives and negatives with these physical tests, that I still feel the most comfortable with the MRI if I am going to place a patient in a removable boot for 3 months. Before MRIs, soft tissue windows for CT Scans were used (alot of radiation), and xerograms (can not remember how useful that was).



I will try to produce a video soon on the bowstringing of the plantar fascia to show you. Until then, I found this nice video that demonstrates the plantar fascia bowstringing.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.