American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptom is characteristic of plantar fasciitis?

1. Pain that improves with prolonged sitting

2. Pain that occurs upon awakening

3. A popping sound with movement

4. Severe redness and swelling

The correct answer is: Pain that occurs upon awakening

Plantar fasciitis is characterized by heel pain that typically worsens with initial weight-bearing activities, especially after periods of inactivity, such as after waking up in the morning. This phenomenon occurs due to the inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot. During the night, the foot is often in a position that allows the plantar fascia to tighten. When a person takes their first steps in the morning or after sitting for a long time, the sudden stretching of this tightened fascia can lead to sharp pain. Pain that improves with prolonged sitting is not typical for plantar fasciitis, as the discomfort generally increases with inactivity followed by sudden movement. A popping sound with movement suggests a different type of joint issue rather than inflammation of the plantar fascia. Severe redness and swelling can indicate a more acute inflammation or injury, which is more common in conditions like tendonitis or an infectious process, rather than the chronic nature of plantar fasciitis. Therefore, the symptom that distinctly indicates plantar fasciitis is pain occurring upon awakening.