Is your heel pain unresponsive to plantar fasciitis treatments? It can be some other issue entirely. Plantar fasciitis is a common but not the only cause of heel pain. You should not rule out the possibility of other conditions like Achilles tendinitis or heel bursitis. Professional diagnosis is necessary for appropriate, on-time treatment.
Plantar fasciitis is a common cause of heel pain. The condition is characterised by sharp pain in the heel, especially after a period of inactivity or prolonged standing. Plantar fasciitis affects millions of individuals globally, and around 10% of adults in Canada.
The problem shows up when your plantar fascia, the thick band of tissue connecting your toes to your heel, gets inflamed or degenerated. However, self-diagnosis can lead to delayed or improper professional care, as plantar fasciitis is not the only cause of heel pain. To learn more about plantar fasciitis, other heel conditions, and their treatment, keep reading.
Common Heel Pain Conditions (Beyond Plantar Fasciitis)
According to the Pedorthic Association of Canada, heel pain is the most common issue that certified Canadian podiatrists treat. And plantar fasciitis is the most common but not the only cause of heel pain. So, before we dive deeper, let’s go through a quick overview of the different common conditions that cause heel pain.
| Condition | Pain Location | Main Symptoms | Aggravating Activity |
| Plantar Fasciitis | Near the Heel (Pain Radiating Towards the Toes) | First-Step Pain, Temporary Relief with Activity, Aching & Stiffness | Prolonged Standing, Periods of Inactivity, Walking, Running & Stair Climbing |
| Achilles Tendinitis | Back of Heel | Stiffness, Swelling & Tightness | Running & Uphill Walking |
| Heel Bursitis | Bottom/ Back of Heel | Redness & Tenderness | Prolonged Standing |
| Heel Spurs | Underside of Heel | Sharp Pain (Especially in the Morning) | Standing & Walking |
| Tarsal Tunnel Syndrome | Inner Ankle to Heel | Burning, Numbness & Tingling | Standing & Walking |
| Fat Pad Atrophy | Center of Heel | Bruised Feeling & Soreness | Walking on Hard Surface |
Table 1: Common Conditions Causing Heel Pain
Achilles Tendinitis: Back-of-Heel Pain Explained
This condition is characterised by inflammation of the Achilles tendon connecting the heel bone and calf muscles.
Causes/Risk Factors
The condition can result from overuse of the Achilles tendon or repetitive stress on it. So, runners and athletes are at risk. Sudden spikes in the duration or intensity of physical activity can also cause Achilles tendinitis. Other causes of the condition include wearing poorly supportive or worn-out footwear, tightness of calf muscles, and loss of tendon flexibility and strength due to ageing.
Symptoms
The most notable symptom of the condition is stiffness and pain along the Achilles tendon, especially after waking up. Worsening pain with activity is another common symptom. You may also experience swelling and tenderness in the area.
Treatment
The Rest-Ice-Compression-Elevation (RICE) method can help you reduce swelling and pain. Physical therapy, like strengthening and stretching exercises for calf muscles, can help. You can go for orthotics like heel lifts or shoe inserts to reduce strain on your tendon. Shockwave therapy can also speed up healing in chronic cases.
You can also get your tendons repaired surgically if non-surgical approaches fail to improve symptoms even after 6 to 12 months.
Heel Bursitis: Inflammation around the Heel Bone
The condition is characterised by the inflammation of a fluid-filled sac under or behind the heel bone, known as a bursa. The sac serves as a cushion for muscles, bones, and tendons.
Causes/Risk Factors
Heel bursitis is typically caused by repetitive pressure on the heel or its overuse. Shoes that are poorly cushioned, have a stiff back, or are too tight can lead to irritation of the bursa. Your heels may also become excessively stressed from repetitive motions from high-impact activities.
Symptoms
Inflammation of the bursa under the heel is a symptom of plantar calcaneal bursitis. When it happens behind the heel, it is a sign of retrocalcaneal bursitis. Pain, tenderness, swelling, and warmth around the heel or affected area are signs of bursitis.
You may feel the pain worsening when your heel gets pressed against surfaces. The skin over your heel’s back may become red, while pain increases when running, walking, or standing on your toes.
Treatment
Resting, icing, and using anti-inflammatory drugs can help reduce the symptoms. Targeted strengthening and stretching exercises for calf muscles and ankles can help reduce symptoms by increasing flexibility.
In case of severe inflammation, you may be given a corticosteroid injection. Excessive fluid may also be drained from a swollen bursa using a needle. In rare cases, there might be a need to surgically remove your inflamed bursa.
Heel Spurs: When Calcium Deposits Create Sharp Pain
Heel spurs can be referred to as calcium deposits that form a bony protrusion.
Causes/Risk Factors
The buildup of calcium happens on the heel’s underside and over several months. The condition happens when your foot’s ligaments and muscles face chronic strain and stress. The pain results from inflammation of the soft tissues surrounding the otherwise painless spurs.
Symptoms
The symptoms of heel spurs often feel like plantar fasciitis. You will experience short and stabbing heel pain, especially when taking the first steps after a period of inactivity. Dull aches may also remain in your heel for the rest of the day. The front of your heel may also feel tender and inflamed.
Treatment
Stretching exercises for the plantar fascia and calves can help. You can also reduce stress on your heels with orthotic inserts and supportive shoes. For reducing pain in the morning, you can sleep wearing a night splint. Another non-invasive way to treat or manage heel spurs is to send high-energy impulses as part of shockwave therapy. It helps trigger the body’s healing process. Finally, if treatments do not work for 9 to 12 months, you can treat the condition surgically.
Tarsal Tunnel Syndrome: Nerve Compression near the Heel
The condition is characterised by the posterior tibial nerve at the ankle getting compressed.
Causes/Risk Factors
Entrapment or compression of the posterior tibial nerve at the ankle is the main cause of tarsal tunnel syndrome. But it can also be caused by injuries like an ankle sprain that creates pressure on the nerve.
Conditions like high arches or flat feet can also cause the issue by increasing tension on the nerve. Tarsal tunnel syndrome can be further caused by abnormal growths like ganglion cysts, inflamed tendons, and bone spurs.
Symptoms
Nerve sensations like numbness, burning pain, tingling, and a needle-piercing feeling along the heel, arch, and nerve’s path are common symptoms. You will feel that your symptoms worsen with prolonged standing, walking, or other activities. Intensifying pain is relieved by rest, and radiating pain can be felt in the foot, ankle, and toes.
Treatment
Rest, icing, and limiting physical activity can help you feel relief. The condition can also be treated using orthotics, bracing, and arch support, which will stabilise and support your foot.
You can also improve foot mechanics and manage symptoms with physical therapy and exercise. If symptoms persist or worsen even with treatment, you may want to go for nerve-releasing surgery.
Fat Pad Atrophy: Cushion Loss That Hurts with Every Step
The condition is characterized by thinning or deterioration of the natural, cushioning layer of fat located under the ball or heel of the foot. Pain is felt as bones and tissues get stressed.
Causes/Risk Factors
Fat pads naturally lose thickness and elasticity with age, and wear down with activities like running and jumping. Being overweight, standing on hard surfaces for a long time, or suddenly increasing physical activity can stress out your foot’s fat pads.
The condition can worsen if you wear high heels, thin-soled shoes, or poorly cushioned footwear. You may also start losing the fat pads due to rheumatoid arthritis, diabetes, and autoimmune diseases. Additionally, repeated steroid injections can result in breakdown of tissues and fat pads.
Symptoms
You may feel like you are walking on stones when barefoot. You will also feel a pain similar to bruises in the centre of the heel or ball of your foot. Pressing the affected area can increase tenderness, and your body will form calluses to provide cushioning. An aesthetic sign of fat pad atrophy is a sunken appearance under the heel.
Treatment
Lost fat pad tissues cannot be regenerated. However, heel cups, shoe inserts, and cushioned orthotics can help manage pain. Applying ice and limiting high-impact activities can offer relief. Running subjects your feet to 3 to 4 times your bodyweight, which can be 7 times more during certain spotting activities. And avoid high-heeled footwear as well. Women face 4 times greater foot problems than men because of wearing high heels.
You can avoid hard surfaces, engage only in lower-impact activities, seek physical therapy, and maintain a healthy weight. Podiatrists also recommended dermal filler injections or fat grafting for recreating the cushion.
Heel Pain Treatment Options by Condition
Here is a comparison of heel pain treatment options for different conditions.
| Condition | Best Initial Treatment | Advanced Options |
| Achilles Tendinitis | Stretching, Ice & Orthotics | Shockwave & Therapy |
| Bursitis | Padding & Anti-Inflammatories | Cortisone Injections |
| Heel Spurs | Stretching & Orthotics | Night Splints & Surgery |
| Tarsal Tunnel | Bracing & Orthotics | Nerve Decompression Surgery |
| Fat Pad Atrophy | Heel Cups | Padding Injections & Custom Orthotics |
Table 2: Heel Pain Treatment Options Based on Condition
When to See a Podiatrist for Heel Pain
Podiatrists are 4 times less likely to recommend costly services compared to general physicians. So, here are the situations in which you should see a podiatrist for heel pain.
- If your foot or heel pain lasts for more than 2 weeks.
- If the foot pain makes walking and sleeping difficult.
- If you observe persistent swelling, redness, or numbness.
Ready to See a Podiatrist?
Your food might hurt for multiple reasons. While plantar fasciitis is the most common cause of foot and heel pain, it is not the only one. You might be suffering from any other foot condition with symptoms similar to plantar fasciitis.
Professional diagnosis is necessary for identifying the right issue and following the most appropriate treatment. Wrong diagnosis, improper treatment, or a one-size-fits-all approach can further worsen your condition. So, book an appointment with a podiatrist near you today!
Frequently Asked Questions (FAQs)
1. How do doctors diagnose a foot disease?
Doctors use a combination of methods for diagnosing a foot disease. They start by going through your medical history, followed by performing physical examinations. Gait analysis may also be performed to measure the degree of foot roll when walking or running. Imaging tests like MRIs, X-rays, and ultrasounds are also done. Your blood may also be drawn for lab testing for the possibility of systemic diseases.
2. Can I treat foot diseases at home?
Yes, some mild foot diseases can be treated at home. Remedies typically include proper hygiene, antifungal creams, and rest. But you must seek medical attention if the infection is serious, pain is persistent, or the condition is caused by diabetes.
3. Can I manage my foot pain long-term with over-the-counter medications?
Over-the-counter medications like acetaminophen or ibuprofen will help you manage some short-term foot pain. But continuous use of pain relievers can lead to side effects. So, managing chronic foot pain in the long term requires a doctor’s advice and specific treatments.
4. Which is more effective for treating foot pain? Physical therapy or injections?
Physical therapy appears to be more effective in the long term for most of the chronic foot issues. Injections offer faster relief, but the effects are temporary. So, most patients combine physical therapy with injections.