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Other conditions can feel similar to Plantar Fasciitis. Here’s how to tell the difference.

Plantar fasciitis pain
Maryke Louw
Maryke Louw
Aug 9, 2021
Foot pain is often misdiagnosed as plantar fasciitis when in fact it’s something else altogether. Getting an accurate diagnosis is essential to ensure treatment success.

What does plantar fasciitis feel like?

anatomy of the plantar fascia

Plantar fasciitis causes pain/stiffness on the inner part of your arch, close to your heel bone. You may also notice a puffiness or a little bit of swelling in that specific area.

The pain is usually at its worst first thing in the morning or when you get up from sitting for a long time.

You may find that doing a little bit of walking helps it to feel more comfortable, but if you do a lot of walking or running it feels more painful. Standing for long periods also tend to flare it up.

Can plantar fasciitis cause calf pain?

Yes, especially if you’ve had it for a while, plantar fasciitis can cause your calf to tighten up and hurt. Doing gentle calf stretches or massage on your calf may provide temporary relief, but you’ll only get rid of the calf pain if you treat the plantar fasciitis.

However, this is only true if your foot pain started first. If your pain started in your calf and eventually caused your heel to hurt, then it may not be plantar fasciitis. It’s more likely referred pain from your calf that is ‘pretending’ to be plantar fasciitis and your physio should look for the cause of your calf pain to ensure a speedy recovery.

Can plantar fasciitis cause ankle, knee, hip, or back pain?

Yes, absolutely. It’s natural to adapt how you walk when you have pain in your foot. This altered gait pattern can cause strain on the muscles, ligaments or joints in the rest of your leg and cause them to hurt. This is one of the reasons why it’s important not to try and push through pain.

The same rule mentioned in the previous section applies here. If your pain started higher up in your body and eventually caused your foot to hurt, then it is likely not plantar fasciitis but referred pain from a different part of your body. This means that, rather than focussing treatment on your foot, you’ll have to find and treat whatever structure is referring the pain to your foot. I discuss some of them in the sections below.

The Exakt Health app contains a treatment plan for plantar fasciitis that starts with easy, low load exercises and intensifies as you recover.

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Can plantar fasciitis cause ankle swelling?

No. The swelling from plantar fasciitis is only located in the area of the inner arch, close to the heel bone. Swelling around the ankle can be coming from the ankle joint or any of the tendons that cross it. The tibialis posterior tendon for instance can cause swelling on the inside of the ankle and pain that feels similar to plantar fasciitis when it’s injured close to where the tendon attached under the foot.

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Can plantar fasciitis cause swelling on top of foot?

No, definitely not. Swelling on top of the foot will likely be coming from either the little joints in your foot, the bones (stress fractures) or the tendons (tenosynovitis) on top of your foot.

What conditions are often misdiagnosed as plantar fasciitis?

Heel spurs do not cause pain and they do not cause plantar fasciitis.

Plantar Fasciitis or Heel Spur

It’s important to understand that heel spurs do not cause pain and you won’t automatically need surgery just because you have a heel spur. I know, your doctor have likely done an x-ray of your foot and identified a spur on you bone and told you that that is why you have pain. It can be quite convincing because there’s this extra pointy piece of bone right in the area where your pain is, but the recent research has shown that this is actually not the case.

Studies have shown that there are lots and lots of people walking around with heel spurs who have no pain. Also, if you have a heel spur in one foot, you very likely also have it on your other foot – the one that doesn’t hurt. And people with heel spurs can fully recover from plantar fasciitis despite the spurs still being present.

So try not to worry about it – your foot will recover if you apply the correct treatment regime.

Plantar Fasciitis or Stress Fracture

Calcaneal (heel bone) stress fractures create pain that can easily be confused with plantar fasciitis. Endurance athletes with a pronounced heel-strike running style or military recruits are prone to developing stress fractures in their heels. However, if you have low bone density (osteoporosis) you can develop this without doing any sport.

How can you decide if your pain is more likely plantar fasciitis or a stress fracture? When you have a stress fracture in your heel, it is often painful to squeeze the sides of the heel bone – this is not the case when you have plantar fasciitis. However, the only accurate way to diagnose a stress fracture is through an MRI scan. X-rays don’t always show it either.

Plantar Fasciitis or Achilles Tendonitis

The plantar fascia runs from your heel bone to your toes and stops your arch from collapsing when you're upright. The Achilles tendon runs from your calf muscles and attaches into the back of your heel.

Where you feel your pain is important to distinguish between plantar fasciitis and Achilles tendonitis. If your pain is on the Achilles tendon or at the spot where it attached into the back of the heel bone, then it’s likely Achilles tendonitis and definitely not plantar fasciitis. If your pain is under your foot, close to the inner part of the heel bone, then it is likely plantar fasciitis and definitely not Achilles tendonitis.

Plantar Fasciitis vs. Tarsal Tunnel Syndrome

These two conditions are often confused, because the pain can be in a very similar location. Tarsal tunnel syndrome is caused by compression or irritation of the tibial nerve as it runs around the inner part of your ankle. The nerve splints into several little branches which go to different parts of the foot.

When someone has tarsal tunnel syndrome, they will often describe their pain as being a burning pain or feeling intermittent sharp stabbing pains (like electric shocks), pins and needles, buzzing, or itching. These types of pains usually indicate that a nerve is irritated. In contrast, the pain from plantar fasciitis is usually described as a combination of tightness, an ache or just very sharp pain.

When you have tarsal tunnel syndrome the pain you feel may also be in more areas under the foot or even close to the bone on the inside of the ankle, rather than just close to the heel. You can also have both conditions at the same time.

Heel Fat Pad Syndrome vs. Plantar Fasciitis

We all have fat pads under our heels that protect our heel bones when we walk. Sometimes this fat pad can become bruised or even thin out (atrophy) which can then cause pain under the heel.

You can tell the difference between plantar fasciitis and heel fat pad pain by palpating the heel.

When you have heel fat pad syndrome, it’s usually painful to press straight down onto the middle of the heel vs. when you have plantar fasciitis it’s more painful to press closer to the inner edge where the plantar fascia attaches.

Also, squeezing the lower edges of the heel bone often hurts when you have fat pad syndrome, while it will likely be pain free when you have plantar fasciitis. The only way to really distinguish between these two conditions is through and ultrasound or MRI scan. However, it is a common finding that people with plantar fasciitis will also have thinner fat pads.

Referred pain from your lower back

Your lower back can also refer pain into your foot. A physiotherapist or doctor can help you test for this by performing the Slump Test. This test is easily performed in the clinic and tests if your sciatic nerve is free to slide.

So you can see that there are several different conditions that can cause pain under your foot and that can easily be confused with plantar fasciitis. This is why it’s important to have your injury diagnosed by an experienced clinician.

Your lower back can refer pain into your foot that can feel similar to plantar fasciitis.

We understand. We’ve been there. Finding convenient and reliable help for injuries online can be a tedious and demoralising process. Here’s our story and why we started Exakt Health.

The Exakt Health App provides a convenient, intuitive and science-based injury rehab experience for runners.

All treatment advice is based on trusted medical evidence and reviewed by licenced sports physiotherapists, with each rehabilitation plan tailored to your unique grade of injury and phase of healing. Download the Exakt Health App and start your recovery now.

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Maryke Louw
Maryke Louw
Maryke Louw is the Medical Lead at Exakt Health and a chartered physiotherapist. She has a BSc in Physiotherapy and an MSc in Sports Injury Management and has been working with athletes of all abilities and ages for more than 20 years. Maryke combines her extensive knowledge of sports injury treatment with the latest research to provide effective injury treatment and prevention advice.
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