Plantar fasciitis and Achilles tendonitis are the most common causes of heel pain with plantar fasciitis being the first and Achilles tendonitis being the second. These two are chronic conditions of the foot. Only a doctor can properly diagnose a heel pain and know the underlying cause of it.
It’s quite difficult to differentiate plantar fasciitis from tendonitis. Both conditions involve acute pain in the heel. It’s important to know the difference between the two conditions to get better treatment and quicker relief for your symptoms. You can’t really tell them apart in the earlier stages of both conditions but as each condition progresses, you will see the differences between them.
- Plantar fasciitis and tendonitis can both be caused by wearing the wrong type of shoes for your foot structure or for your sport. Wearing high heels for prolonged periods can also cause both conditions.
- The pain for both conditions can be felt just above the heel or in the heel.
- The pain can be felt when getting up after sitting for a long time.
- The pain strikes in the first 5 to 10 minutes of walking or running.
- The pain can get worse when running or when walking up a hill.
- The pain is much worse when walking or running faster compared to doing it slower.
- Both conditions are usually caused by overuse whether by walking or by running most especially when the activity is done uphill.
- Both conditions can be improved by correcting the running form.
- The biggest difference between plantar fasciitis and tendonitis is the location of the pain. The pain brought about by plantar fasciitis usually occurs on the underside of the foot and on the heel while the pain brought about by tendonitis can occur in many parts of the foot except for the underside of the foot. The location of the pain in tendonitis depends on the type of tendonitis.
- Another difference between the 2 conditions is the worsening of the pain throughout the day. The heel pain in plantar fasciitis usually occurs in the morning as soon as you get out bed and make your first step. The heel pain caused by plantar fasciitis tends to get better with activity. The heel pain in tendonitis has a tendency to get worse with activity.
- Achilles tendonitis gets worse when walking on tiptoes or when rising up on your toes. This doesn’t happen to plantar fasciitis.
- Plantar fasciitis responds to a certain taping technique but it doesn’t work with tendonitis.
- The pain caused by Achilles tendonitis is relieved a little by elevating the heel when laying down and by avoiding minimalist shoes such as barefoot, flip flops, and/or zero drop running shoes.
Plantar Fasciitis Overview
Plantar fasciitis is the inflammation and irritation of the thick band of tissue found at the bottom of the foot that connects the heel to the ball of the foot caused by strain or micro tearing. The pain is usually felt at the bottom of the heel.
Causes of Plantar Fasciitis
- Obesity, sudden weight gain or chronic weight issues that put strain on the arches of the foot
- Being flat-footed or having a high foot arch
- Extended periods of standing on hard surfaces
- Prolonged use of footwear without the proper cushioning or arch support
- Long distance walking or running and walking or running on uneven surfaces
- Tight Achilles tendon
- Sudden increase in the mileage, pace, speed, distance, and plyometrics
Symptoms of Plantar Fasciitis
- The heel pain is at its worse upon getting out of bed in the morning or standing up from a prolonged sitting.
- The pain subsides after walking for a couple of minutes and usually gets worse as the day progresses.
- The pain is severe when climbing stairs or doing the intense activity.
- Aching arches and stiffness in the heel
- Redness and swelling of the heel and arch
- Symptoms improve with rest and by putting an ice pack on the affected area
- Sharp pain in the heel and fascia that typically causes limping
The pain brought about by tendonitis can be focused in different parts of the foot depending on the type of tendonitis that a person has. The pain can be felt on the front, top, back, or side of the foot except for the fascia.
Achilles tendonitis is the most common type of tendonitis which is caused by a strain on the Achilles tendon, the thick band of tissue that connects the calf muscles to the heel bone, which brings about swelling and pain. Achilles tendonitis can be a result of repetitive motion required for jogging or running.
Causes of Tendonitis
- Running without wearing the proper footwear or cushioning especially when running on hard surfaces
- Running injuries
- Overuse by running
- Increasing the distance, frequency, pace, or speed of your run
Symptoms of Tendonitis
- Pain in the early stages can only be felt after running but as the condition gets worse, the pain is felt during the run.
- Pain is worse at the start of the day
- Pain above the heel or in the back of the leg that gets worse with increased activity
- Increased pain after more strenuous activity
- Swelling and redness
- Stiffness in the ankle and foot
- A painful lump may develop at the tendon
Diagnosis and Treatment of Plantar Fasciitis and Tendonitis
To diagnose plantar fasciitis, the doctor carefully examines the arch and heel and usually recommends an x-ray. If the fascia or the area between the heel and the ball of the foot appears thicker than normal and is inflamed and if the x-ray results show bone spurs, the doctor will most likely diagnose plantar fasciitis. Hairpin fractures in the bones around the foot may also indicate that a person has plantar fasciitis.
To diagnose tendonitis, the doctor does a physical exam of the foot and may require MRI to determine whether there is a tear or damage in the tendons in the foot.
The pain caused by plantar fasciitis and tendonitis can be alleviated through the following:
- Gentle stretching and exercises
- Applying ice to the affected area
- Wearing shoes with proper cushioning or support
- Taking over-the-counter anti-inflammatory medications to manage the pain like ibuprofen but it should only be done with advice from the doctor
- Avoiding inflammatory foods
- Decreasing activities causing pain
- Physical therapy
For severe cases of plantar fasciitis, the doctor may require the use of a specialized splint when sleeping to slowly stretch and correct the plantar fascia and facilitate healing. Surgery to correct plantar fasciitis is rare.
For severe cases of tendonitis, the doctor may recommend using steroid injections. Surgery is only required when the other treatments have failed or in case of a tendon rupture.