A patient has suspected plantar fasciitis. The plantar fascia is best examined:

• A. with the great toe dorsiflexed.
• B. with the foot in neutral position.
• C. while the patient stands.
• D. with the ankle at a 90 degree angle.

Answer: (A)

The key idea is that the plantar fascia becomes taut when the big toe is dorsiflexed, by the windlass mechanism. Extending the great toe tightens the fascia, raises the medial arch, and increases tension along its course from the heel to the toes. If plantar fasciitis is present, palpating the plantar fascia while the big toe is dorsiflexed will reproduce the sharp, focal pain at its medial calcaneal insertion, making this position the most sensitive way to assess it. Positions that keep the foot neutral or place less stretch on the fascia—like neutral foot, standing, or an ankle at 90 degrees—do not stretch the fascia as effectively and are less helpful for eliciting the characteristic tenderness.