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Beyond Plantar Fasciitis: Other Conditions That Can Cause Plantar Heel Pain

Understanding Plantar Heel Pain

While plantar fasciitis is one of the most common causes of heel pain, it is not the only condition that can lead to discomfort in this area. As a functional medicine podiatrist, it’s essential to consider a holistic view of the patient’s health to identify other potential causes of plantar heel pain. In this blog post, we’ll explore several other conditions that might be contributing to your discomfort.

1. Bursitis

What Is Bursitis?

Bursitis involves inflammation of the bursa, a small fluid-filled sac that cushions and lubricates areas where muscles, tendons, and bones rub against each other. In the heel, this condition is often due to overuse or repetitive strain.

Symptoms

  • Pain and tenderness in the central plantar heel

  • Swelling and redness

  • Increased pain with movement, standing, or pressure

Treatment

  • Rest and ice

  • Anti-inflammatory medications

  • Proper footwear

  • Inserts with a cut-out for the bursa

  • Steriod injection

2. Tarsal Tunnel Syndrome

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it passes through the tarsal tunnel, a narrow space inside the ankle. This condition can lead to pain and numbness in the heel and the bottom of the foot.

Symptoms

  • Burning or tingling sensation in the heel and foot

  • Pain worse at the end of the day

  • Pain with prolonged standing

  • Pain that radiates from the inside of the ankle

  • Numbness or a "pins and needles" feeling in the arch that may extend to the toes

Treatment

  • Anti-inflammatory medications topically 

  • Laser therapy

  • Orthotics to support the arch

  • In severe cases, surgical intervention

3. Sever’s Disease

What Is Sever’s Disease?

Sever’s disease, or calcaneal apophysitis, is a common cause of heel pain in growing children and adolescents. It occurs due to inflammation of the growth plate in the heel.

Symptoms

  • Pain in the back or bottom of the heel with activity

  • Pain with manual compression of the heel

  • Swelling and redness

  • Pain that worsens with physical activity

Treatment

  • Rest and ice

  • Shockwave therapy

  • Tapain

  • Stretching exercises for the Achilles tendon and calf muscles

  • Proper footwear with good heel support

  • Avoiding high-impact activities

4. Achilles Tendinitis

What Is Achilles Tendinitis?

Achilles tendinitis involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. Overuse or sudden increases in physical activity can lead to this condition.

Symptoms

  • Pain and stiffness along the Achilles tendon

  • Pain that worsens with activity

  • Swelling and tenderness

Treatment

  • Rest and ice

  • Shockwave, laser, taping

  • Stretching and strengthening exercises

  • Proper footwear and orthotics

  • Anti-inflammatory medications

5. Fat Pad Atrophy

What Is Fat Pad Atrophy?

The fat pad under the heel acts as a natural cushion, absorbing shock and reducing pressure. Over time, this fat pad can thin out, leading to heel pain.

Symptoms

  • Deep, aching pain in the heel

  • Pain that worsens with prolonged standing or walking

Treatment

  • Cushioned insoles or heel cups

  • Proper footwear with good shock absorption

  • Reducing high-impact activities

  • Fat pad injections

6. Stress Fractures

What Are Stress Fractures?

Stress fractures are small cracks in the heel bone caused by repetitive stress or overuse. They are common in athletes and individuals who engage in high-impact activities.

Symptoms

  • Gradual onset of heel pain

  • Pain that worsens with activity and improves with rest

  • Swelling and tenderness

  • Pain with manual compression of the heel

Treatment

  • Immobilization

  • Rest and avoid weight-bearing activities

  • Shockwave

  • Ice therapy

  • Proper footwear

7. Plantar Fascial Rupture

What Is Plantar Fascial Rupture?

A plantar fascial rupture is a tear in the plantar fascia, which can occur suddenly due to trauma or gradually from chronic overuse.

Symptoms

  • Sudden, intense pain in the heel or arch

  • Swelling and bruising

  • Difficulty walking or bearing weight on the affected foot

Treatment

  • Rest and ice

  • Immobilization with a cam walker boot or cast

  • Physical therapy for rehabilitation

Plantar heel pain can result from various conditions, not just plantar fasciitis. Understanding these different causes is crucial for accurate diagnosis and effective treatment. As a functional medicine podiatrist, I emphasize a comprehensive approach to treating heel pain, considering all possible contributing factors to develop a personalized treatment plan. If you’re experiencing persistent heel pain, it’s important to consult with a healthcare professional to determine the underlying cause and receive appropriate care.

For more information or to schedule an appointment, contact Lighthouse Foot and Ankle Center in Scarborough, Maine at 207-774-0028 or visit our website at www.lighthousefootandankle.com.