Heel Pain? It Might Not Be Plantar Fasciitis – Here’s What Else It Could Be

First of all, let’s discuss what we mean by plantar fasciitis. This term is not the most accurate, and instead, we should probably refer to this injury as plantar fasciosis. This distinction is important because, rather than inflammation being the primary culprit, this condition is often more linked to a degenerative process. Alternatively, we could call it plantar fasciopathy, which is a broader term describing any pathology of the plantar fascia.

Plantar fasciopathy is often diagnosed clinically without the need for imaging. Some common findings that suggest plantar fasciopathy include:

• Pain on palpation around the medial heel area.
• Pain with the first few steps in the morning.
• A history of prolonged standing (common in certain occupations) or being overweight.
• A recent spike in training load.

There are more features to plantar fasciopathy than the above, but we’ll leave it at that for the sake of keeping this article concise.

When Heel Pain Might Be Something Else

The location and pattern of pain can often indicate that another condition is at play. Here are some possibilities based on the pain’s location and symptoms:

Location-Based Differentiation

• Slightly more distal pain (closer to the toes) may suggest a plantar fascia tear rather than general fasciopathy.
• Pain higher in the arch could be related to the tibialis posterior tendon, which attaches to the navicular bone at the top of the arch.
• Central heel pain (rather than on the medial side) may indicate a fat pad bruise or irritation.
• Pain at the back of the heel could be due to insertional Achilles tendinopathy or retrocalcaneal bursitis.

Symptom-Based Differentiation

• Burning or radiating pain may be linked to nerve compression, commonly affecting a branch of the lateral plantar nerve known as Baxter’s nerve.
• Pain that worsens with activity and lingers after exercise may indicate stress fractures of the calcaneus (heel bone).
• Pain that worsens after prolonged rest but improves with movement may suggest an inflammatory condition, such as spondyloarthritis.
• Pain that changes depending on footwear might suggest fat pad atrophy, where the natural cushioning of the heel has worn down over time.

What Should You Do Next?

If your heel pain isn’t improving, or if it doesn’t match the typical signs of plantar fasciopathy, it’s a good idea to see a podiatrist for a thorough assessment. A proper diagnosis ensures that you receive the right treatment and don’t waste time on ineffective strategies.

At Achieve Podiatry, we specialise in diagnosing and treating all types of heel pain. Whether it’s plantar fasciopathy or another condition entirely, we can guide you toward the best treatment options to get you back on your feet—pain-free.

Book an appointment today and take the first step toward relief!