In this video I'm going to show you two important tests that I use to diagnose plantar fasciitis.
And to make sure it's not something else that could be masking like plantar fasciitis. These
tests are critically important for your health care provider to do they're not
commonly done. The most common way that plantar fasciitis is done is people don't
even touch you healthcare professionals don't even have you take off your shoe or your sock.
They don't really examine you, they just asked you, are you having heel pain? Is it hurting
first few steps in the morning? Okay, then you have plantar fasciitis and they diagnose it
and then they'll tell you to go start a treatment for plantar fasciitis when in reality you may not
actually have plantar fasciitis. So let me show you the two tests.
The first test is a plantar fascia tension test. Now on my skeleton here, I've got a yellow strip
and a purple strip the purple strip is to signify the plantar fascia and the yellow
strip is to signify the nerves in the area. There's a sciatic nerve that runs from the hip
lower back area down to the back of the knee and it changes names but it's the same nerve branches
that run into the heel all the way to the tips of the toes, kind of along with the plantar fascia.
Now the plantar fasciitis starts at the heel and runs out to the toes. So to do a tension test
on the plantar fascia, you've simply got to peel the toes back and you can see how that's going to
tension everything. But if I haven't tensioned up into the sciatic nerve in the hip, knee and back
then I'm teasing out the plantar fascia. So what I'll do with patients is
I'll push right here about where people get the plantar fascia pain. And just in resting without
pulling the toes back, I'll poke and push on the on the plantar fascia. And if that is painful,
it could be the plantar fascia, or it could also be the nerve in the area, there's branches off
this big nerve that run into right under the plantar fascia insertion right at the heel.
So if that is tender, I don't really know yet if it's plantar fasciitis,
or if it's a nerve problem, but if I add tension to the plantar fascia, you can see it's coming
off here because I'm already tensioning it this is paper. If I add tension to it,
and then press it, I've taken the plantar fascia off the nerve, because I'm straightening it out,
it runs through the arc of the foot. So when I extend the toes here,
the plantar fascia straightens out like that. It's easier to feel as well, when you do this as a as
a health care provider, then I can press into it. If it hurts at that point, then I'm beginning to
think yeah, it's more likely going to be plantar fasciitis because I have tension the plantar
fascia, and I'm poking it and it hurts. Now, if I tension it, and I poke it,
and it does not hurt, and there's something else going on, you probably don't have
plantar fasciitis, you have something else that's masking like plantar fasciitis. Now,
there's a variety of things. But the most common condition that I find here in the clinic is a
nerve entrapment, or a nerve irritation, that's from a nerve that's running right through the
area of the plantar fascia insertion at the heel. And so this leads me to my second test that will
do to differentially diagnose or cross diagnose, I'm trying to rule out plantar fasciitis at this
point completely in trying to rule in another problem, a nerve problem. So what I'll do is
I'll keep that tension on the toes, and then I'll cradle the leg and pick up the whole leg.
You can see this is all coming off. But right there is that big yellow nerve.
If I'm tensioning the nerve at this point, and it is causing the heel pain to come on.
I know for a fact that that is way more likely going to be a sciatic nerve problem. Masking as
plantar fasciitis at the heel because it's causing heel pain, and it'll cause pain with the first
few steps after getting up. You've been still all night long, your nerves just hadn't moved
a whole lot. And so when you go to move, it can begin to be painful to put pressure on the area.
Another common sign that I'll use to figure out this is a nerve problem is I'll just
feel the nerve and if the nerve is tender, the pathway of the nervous tender going up into the
inside of the ankle into the calf, the back of the knee all the way up into the thigh and hip,
then that is more evidence that this is a nerve issue
rather than a plantar fasciitis problem because the plantar fascia does not go up past the heel.
It doesn't run into the ankle definitely doesn't go into the calf, or the knee, hip or thigh.
Now the reason why this is important, the whole reason why I made this video is because
here in my office, whenever I get plantar fasciitis patients, I'd say nine out of 10
of them don't really have plantar fasciitis. They have a nerve problem more commonly and
occasionally there's another problem, not a nerve problem or plantar fasciitis is a
joint problem in the foot. One of the joints inside the feet are tender or they're irritated
or stuck and that has to be addressed Another problem that it could be is muscles, there's a
bunch of muscle tendons are into the area. And those could be influencing the heal movement.
And so it gets more complicated at that point. I don't want to go into those details
on this video. But what's relevant for you is the treatment because the whole point of diagnosing
a problem is to then figure out what treatment needs to happen to address that problem. And if
you've been told you have plantar fasciitis, and you really don't, then the treatments probably
not going to help you very much because it's treating the wrong body part, the wrong tissue,
the wrong structure in the foot. If you're trying to do treatment for the plantar fascia,
but you really have a nerve problem, you're not going to get very far.
But if you have identified that you have a nerve problem and you're doing treatment
for nerve problem, that you're going to resolve the issue more likely. Now common treatment for
plantar fasciitis is going to be stretching the area strengthening muscles in the area,
there's all kinds of devices and tools out there to stretch the area, massaging the calf muscles,
massaging muscles in the foot as well. There's lots of treatment out there that a
lot of different practitioners are pretty good at and if you had resolution of your heel pain, then
you probably had plantar fasciitis if you had that kind of treatment. But as you have not had relief
from your heel pain, even though you've been doing a plantar fasciitis treatment regiment, then you
have something else going on. And if you can connect it to a hip pain, knee pain or back pain
problem, you likely have a nerve issue going on. And there needs to be treatment done up higher
into the body as high as your back maybe even higher than that. But oftentimes, we're treating
people's back problems as well as their hip problems and knee problems in order to relieve
heel pain that's coming from a nerve problem. Sciatica is often coupled with this. And so
that's what I would suggest you do if you have heel pain, and you suspect that it's more nerve
related rather than true plantar fasciitis, then you need to start doing sciatica type exercises.
I've got a playlist full of sciatica help videos down in the description below.
So go check that out if you think that you've got a sciatica problem or nerve problem running into
the heel causing plantar fasciitis like problems. Hope this video was helpful for you drop a comment
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