Symptoms:
(1) chronic, intermittent pain in the inferior heel that is worse with weight-bearing in the morning or after a period of inactivity
(2) pain lessens with activity but then recurs towards the end of the day or after prolonged weight-bearing
(3) limping
Physical examination:
(1) Palpation shows a localized area of maximum tenderness over the anteromedial aspect of the inferior heel.
(2) Some patients may show a tight Achilles tendon with limited ankle dorsiflexion.
(3) Some patients are overweight or obese.
(4) Some patients show pes planus (excessive pronation) or pes cavus (high arch).
Ultrasonography
(1) thickening of the plantar fascia (>= 5 mm)
(2) hypoechogenicity at the calcaneal insertion
(3) heel spur (can be seen on foot radiographs)
Differential diagnosis:
(1) Peripheral neuropathy associated with diabetes mellitus needs to be excluded in an obese patient. Dellon (2001) used the Pressure-Specified Sensory Device to help identify these patients.
(2) Findings which should prompt search for another cause: diffuse foot pain, nocturnal pain, burning pain, radiating pain, bone pain
