Heel Pain vs Plantar Fasciitis: What’s Actually Causing Your Pain?
- My Family Podiatry
- 2 days ago
- 6 min read
Heel pain is one of the most common reasons people book an appointment at My Family Podiatry. Most patients arrive already convinced they have plantar fasciitis. In many cases, that is correct. However, it is not uncommon for heel pain to be coming from a different structure, or for more than one issue to be involved.
Heel pain is a symptom, not a diagnosis. While plantar fasciitis is a frequent cause, it is not the only one. We regularly see patients from Albany Creek and across North Brisbane who have been stretching, icing or resting for weeks without improvement because the treatment does not fully match what is actually causing their pain.
This blog explains the difference between general heel pain and plantar fasciitis, why the two are often grouped together, and why identifying the exact source of pain matters for recovery.
Why Heel Pain and Plantar Fasciitis Are So Often Confused
Plantar fasciitis is the most well known cause of heel pain, so it often becomes the default diagnosis (even amongst some health professionals). The problem is that several structures around the heel can produce very similar symptoms.
Common reasons heel pain is mislabelled include:
Morning pain is assumed to always be plantar fasciitis
Internet advice treats all heel pain the same
Stretching is used without understanding what tissue is irritated
Footwear is changed without assessing biomechanics
In clinic, we often find that plantar fasciitis is part of the picture, but not the whole story. This is especially true when pain has been present for several months or keeps returning.
What Is Plantar Fasciitis?
Plantar fasciitis involves irritation and degeneration of the plantar fascia, which is a thick band of connective tissue running along the underside of the foot from the heel toward the toes.
Typical symptoms include:
Sharp or stabbing pain under the heel with the first steps in the morning
Pain after periods of rest such as sitting or driving
Pain that improves slightly as you warm up, then worsens later in the day
Local tenderness under the heel
Plantar fasciitis is primarily a load related condition. The fascia becomes irritated when the load placed through it exceeds what it can tolerate. This load may come from activity changes, prolonged standing, poor foot mechanics or footwear that does not support the foot properly.
Other Common Causes of Heel Pain We See
When heel pain does not respond as expected, we often find another structure contributing to symptoms.
Heel Fat Pad Irritation
The fat pad under the heel helps absorb impact. Over time, or following repetitive loading, it can become irritated or lose its ability to cushion effectively. This can also occur with single traumatic forces being applied to the heel fat pad.
This type of heel pain is often:
Central under the heel
Worse on hard floors
Worse when barefoot or in thin shoes
Stretching usually provides little relief in these cases, which is why symptoms can linger.
Achilles Insertional Pain
Pain where the Achilles tendon attaches to the heel can feel like heel pain rather than ankle pain.
This is often aggravated by:
Hills or stairs
Sudden increases in walking or running
Stiff footwear rubbing the back of the heel
Management here is very different to plantar fasciitis and aggressive stretching can worsen symptoms.
Nerve Related Heel Pain
Nerve irritation can cause heel pain that feels sharp, burning or electric.
Signs it may be nerve related include:
Pain that changes with foot position
Tingling or burning sensations
Pain that does not improve with rest
This type of pain can respond to some of the same treatments as plantar fasciitis such as orthotics but is different in it's pathology.
Bone Stress and Impact Related Pain
In some cases, particularly in runners or people on their feet all day, heel pain may be related to bone stress or repetitive impact.
This pain is usually:
Constant rather than intermittent
Worse with weight bearing
Not relieved by stretching
Imaging may be required when this is suspected.
Key Differences Between Plantar Fasciitis and Other Heel Pain
Plantar fasciitis typically causes pain that is worst after rest and improves slightly with movement. Other causes may produce pain that worsens the longer you are on your feet, feels deeper or does not respond to stretching.
If your symptoms are not improving after several weeks of consistent management, it is worth reassessing the diagnosis rather than persisting with the same approach.
Why Heel Pain Becomes Ongoing
Heel pain rarely becomes chronic because nothing was done. More commonly, it becomes persistent because the treatment does not fully address the cause.
We commonly see heel pain persist due to:
Continuing activity without modifying load
Wearing shoes that feel comfortable but offer little support
Treating symptoms without assessing foot mechanics
Delaying professional assessment
Early identification of the contributing factors leads to quicker recovery and fewer recurrences.
How We Assess Heel Pain at My Family Podiatry
A proper heel pain assessment looks beyond the painful area itself.
Our podiatrists assess:
Foot posture and movement
Walking and running gait
Load tolerance and recent activity changes
Footwear habits
Work and lifestyle demands
Diagnostic ultrasound may be used to confirm which structures are involved and guide treatment decisions.
This approach allows treatment to be targeted rather than generic.
Treatment Options Based on the Cause
Custom Orthotics
Custom foot orthotics are often used to reduce strain on overloaded tissues and improve how force is distributed through the foot.
They are most effective when combined with appropriate footwear and load management.
Shockwave Therapy
Shockwave therapy is useful for stubborn heel pain that has not responded to conservative treatment.
It works by:
Stimulating tissue healing
Improving blood flow
Reducing pain sensitivity
We use EMS Dolorclast focused and radial shockwave therapy at My Family Podiatry where appropriate.
Strengthening and Load Management
Rest alone rarely resolves heel pain long term. Progressive strengthening helps tissues adapt and tolerate load again.
This may include:
Targeted strengthening exercises
Gradual return to activity
Modifying training volume and intensity
Footwear Changes
Footwear plays a major role in heel pain management, particularly for people who stand or walk on hard surfaces throughout the day.
Supportive shoes matched to your foot type can significantly reduce symptoms.
When to See a Podiatrist for Heel Pain
You should book an assessment if:
Pain has lasted longer than two to three weeks
Morning pain is worsening
Pain is affecting work or exercise
You are unsure what structure is causing the pain
Early assessment leads to better outcomes.
FAQs
Is heel pain always plantar fasciitis?
No. Plantar fasciitis is a common cause of heel pain, but it is not the only one. Heel pain can also come from the heel fat pad, Achilles tendon insertion, nerve irritation or bone stress. When pain does not improve as expected, another structure may be contributing.
How do I know if my heel pain is plantar fasciitis?
Plantar fasciitis typically causes sharp pain under the heel with the first steps in the morning or after rest. The pain often eases slightly with movement but returns later in the day. A podiatry assessment is the most reliable way to confirm the cause.
Why is my heel pain not improving with stretching?
Stretching alone does not address all causes of heel pain. If the pain is coming from the heel fat pad, nerve irritation or bone stress, stretching may provide little benefit. Ongoing pain usually means the load on the foot has not been properly managed.
Should I stop exercising if I have heel pain?
High impact activity may need to be modified, but complete rest is rarely required. The goal is to reduce excessive load while maintaining movement where possible. A podiatrist can guide safe activity levels based on the cause of your pain.
Can shockwave therapy help heel pain?
Shockwave therapy can be effective for persistent heel pain that has not responded to conservative care. It is commonly used for plantar fasciitis and other chronic soft tissue conditions when symptoms have been present for several months.
Do orthotics fix heel pain permanently?
Orthotics do not fix heel pain on their own. They help reduce strain on overloaded tissues and improve how force moves through the foot. They are most effective when combined with appropriate footwear, strengthening and load management.
When should I see a podiatrist for heel pain?
You should seek assessment if heel pain lasts longer than two to three weeks, worsens over time, affects work or exercise, or does not respond to basic self management. Early assessment often leads to faster recovery.
Heel Pain Treatment in Albany Creek and North Brisbane
We see patients from Albany Creek, Bracken Ridge, Aspley, Strathpine and across North Brisbane every week for heel pain.
Our approach is simple. Identify the cause, reduce excessive load and improve long term tissue capacity.
Heel pain does not need to become something you just put up with.
Final Thoughts
Plantar fasciitis is a common cause of heel pain, but it is not the only one. When pain persists or does not respond as expected, there is often another contributing factor involved.
Understanding what is actually causing your pain is the key to resolving it properly. If your heel pain is not improving or you are unsure what is driving it, a podiatry assessment is the most effective next step.
Book an appointment with My Family Podiatry in Albany Creek and get clear answers about your heel pain.