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When is Foot Pain Not Plantar Fasciitis

Heel pain is a common problem that can affect anyone, but it's especially common in runners. If you're a runner who's experiencing heel pain, it's important to know that there are many possible causes beyond just plantar fasciitis for this pain. In this post, we'll explore some of the most common causes of heel pain and how they can be diagnosed.

The Mayo Clinic has defined plantar fasciitis pain as that stabbing pain that occurs over the medial tubercle of the heel (the bottom surface of your heel toward the inside part of your foot) with the first few steps in the morning that improves as you get up and move around for a bit, but might return after long periods of standing or when you stand up after sitting. This is typically not something that will get worse with activity.

Doesn't sound like what you have going on? Read on.

The first step in diagnosing pain is to identify where exactly the pain is located. Heel pain can occur in different parts of the heel, and each location can point to a different possible cause. The three main areas of the heel are the bottom (plantar) surface, the back (posterior) surface, and the side, medially on the inside, or laterally, on the outside of the heel's surface.

If the pain is on the bottom of the heel, it can certainly be due to plantar fasciitis. This is when the thick band of tissue that runs along the bottom of the foot becomes inflamed. Plantar fasciitis is usually diagnosed based on a physical exam, and includes the symptom presentation previously described. Other things often associated with plantar fasciitis are altered big toe joint mobility and strength, gait deviations and changes to ankle mobility.

If the pain is on the back of the heel, it could be caused by Achilles tendonitis. This is when the tendon that connects the calf muscles to the heel bone becomes inflamed. Achilles tendonitis is also usually diagnosed based on a physical exam, and will be more painful with increased activities that require a push off of the foot (ie. running up hill, sprinting or jumping).

Pain that is on either side of the heel, but not on the plantar surface might be caused by a condition called retrocalcaneal bursitis. This is when a small fluid-filled sac near the heel bone becomes inflamed due to the Achilles tendon being tight and rubbing over the bursa and would also get worse with increased activity.

There are also some less common causes of heel pain in runners, such as stress fractures, nerve entrapment, or even systemic conditions like arthritis. These conditions may require additional testing such as an X-ray, MRI, or blood work to either rule in or rule out.

In summary, if you're a runner experiencing heel pain, it's important to identify where exactly the pain is located in order to determine the most likely cause. Plantar fasciitis, Achilles tendonitis, and retrocalcaneal bursitis are the most common causes of heel pain in runners, but other conditions may be at play. Not all conditions are created equal, thus they are not all treated the same. If you're unsure what's causing your heel pain, a frozen water bottle, inserts and calf stretch might not always be the answer. It's always best to consult with your physical therapist to help you diagnose and treat your pain with a personalized and comprehensive treatment plan.

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