Plantar Fasciitis — SCE Rheumatology MCQ

Correct answer: C — Plantar fasciitis

The diagnosis is plantar fasciitis (plantar fasciopathy). The discriminating features are plantar heel pain that is maximal with the first steps after rest, focal tenderness at the medial calcaneal origin of the plantar fascia, and supportive ultrasound evidence of fascial thickening and hypoechogenicity. Ultrasound supports the clinical diagnosis rather than being invariably required. Tarsal tunnel syndrome usually causes burning pain or paraesthesia in the tibial nerve distribution. A calcaneal fracture would generally follow trauma or repetitive loading and cause bony tenderness, including pain with calcaneal compression. Morton neuroma causes interdigital forefoot pain, while Achilles tendinopathy produces posterior heel or tendon pain rather than plantar medial calcaneal tenderness. Rheumatoid arthritis does not alter the most likely diagnosis here.

Reference: NHS. Plantar fasciitis, symptoms section. Last reviewed 14 February 2025. https://www.nhs.uk/conditions/plantar-fasciitis/