Plantar Fasciitis or Something Else? How Heel Pain Is Assessed

While plantar fasciitis accounts for the majority of heel pain cases, other conditions, including heel spurs, Achilles tendinopathy, nerve entrapment (Baxter's neuropathy), fat pad atrophy, and calcaneal stress fractures, can produce similar symptoms. A chiropodist uses a combination of history, physical examination, and sometimes imaging to assess what is contributing to the pain.

Seek prompt care if:

• Heel pain appeared after a fall, direct impact, or sudden increase in activity (possible fracture)
• The pain does not improve at all with rest: or worsens at night
• You notice swelling, warmth, redness, or discolouration around the heel
• Numbness or burning accompanies the heel pain
• Pain has persisted for more than 4 weeks despite rest and home care

Plantar fasciitis has several characteristic features:

• First-step pain: Sharp pain under the heel with the first steps in the morning or after rest
• Gradual onset: The pain usually develops over days to weeks, not suddenly
• Improves then worsens: Pain eases after walking a few minutes, then returns after prolonged standing or activity
• Tender spot: Pressing on the medial heel (inside edge) typically reproduces the pain
• Related to load: Pain is worse on hard surfaces, in flat shoes, and after long days on your feet

See our detailed guide: Heel Pain When You First Get Out of Bed.

Heel Spur A bony growth on the heel bone. Many people have heel spurs without pain, and not everyone with plantar fasciitis has a spur. They often coexist but are distinct conditions.

Baxter's Neuropathy Compression of a small nerve (the inferior calcaneal nerve) near the heel. This can cause burning or aching heel pain that does not follow the classic "first-step" pattern.

Achilles Tendinopathy Pain at the back of the heel where the Achilles tendon inserts. It may worsen during or after exercise rather than with the first morning steps.

Fat Pad Atrophy Thinning of the heel's natural cushion, more common with age. Pain tends to be centrally located under the heel and worsened by walking on hard surfaces.

Calcaneal Stress Fracture A small crack in the heel bone. Pain is typically constant (not just first-step), worsens with any weight-bearing, and may be accompanied by swelling.

A thorough assessment includes:

• Detailed history: When pain started, aggravating and relieving factors, footwear, activity changes
• Physical examination: Palpation of the heel and surrounding structures, range-of-motion testing, and specific provocation tests
• Biomechanical assessment: Evaluating foot structure, arch type, and gait to identify contributing factors
• Imaging when indicated: X-ray to check for fractures or spurs; ultrasound to visualise the plantar fascia thickness and rule out tears

Based on the findings, treatment is targeted to the specific cause, which is why accurate assessment matters. Treatments range from stretching and custom orthotics to shockwave therapy for chronic cases.

References:

• Thomas, M.J. et al. (2019). Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors. BMC Musculoskeletal Disorders, 20(1), 53.
• Mayo Clinic: Plantar Fasciitis: mayoclinic.org

This article is for general information only and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.

If you are in Vaughan or nearby York Region communities and your symptoms persist, worsen, or affect walking, an in-person foot assessment can help determine the appropriate next step. Book an appointment online or call (647) 689-7533.