You wake up, and the moment your heel touches the floor, a sharp, unexpected pain stops you in your tracks. Your planned hike on the M trail is ruined. You've heard of plantar fasciitis—maybe you've even wondered if that's what you're dealing with. But what if something else is causing your discomfort?
Heel pain has many possible sources. Although plantar fasciitis is the most well-known, several other conditions can feel surprisingly similar. Treating the wrong issue can delay real relief. At Alpine Foot & Ankle Clinic, our Missoula podiatrist, Dr. Gregg Neibauer, has spent more than two decades helping patients uncover the true cause of their symptoms so they can get back to the activities they enjoy.
What Makes Plantar Fasciitis Feel the Way It Does?
Plantar fasciitis occurs when the thick band of tissue along the bottom of your foot becomes irritated and inflamed. That sharp pain with your first step in the morning? It's one of the most recognizable signs. Discomfort often improves as you get moving, only to return after long periods of standing or when you rise after sitting.
Pain from plantar fasciitis typically centers near the heel, especially where the arch meets the heel bone. It often starts as a sharp, sudden sensation and may settle into a steady ache as the day goes on. Many people describe it as feeling like they're stepping on a deep bruise or even tiny shards of glass.
Several factors increase the likelihood of developing this painful heel condition:
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Sudden activity increases. Going from the couch to marathon training sessions stresses the fascia beyond its capacity.
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Foot structure. High arches or flat feet change how weight is distributed across your heel and can strain the tissue.
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Age and wear. The fascia loses elasticity over time, making it more prone to small tears and inflammation.
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Occupation. Jobs that require hours on hard surfaces, from teachers to retail employees, put constant pressure on the heels.
When Heel Pain Isn't Plantar Fasciitis at All
Other conditions can mimic plantar fasciitis so closely that even seasoned athletes misinterpret their symptoms. If your heel pain isn't improving, one of these issues may be the real culprit.
Heel Bursitis: Deep, Aching Discomfort
Bursitis occurs when the small, fluid-filled sacs that cushion your bones and tendons become inflamed. When the bursa beneath your heel is irritated, it creates a deep ache that worsens with direct pressure. Unlike plantar fasciitis, discomfort doesn't reliably improve as you move, and it may feel more pronounced by the end of the day.
Stress Fractures: Persistent, Localized Pain
Repetitive impacts, such as long-distance running or a sudden increase in training intensity, can lead to tiny cracks in the heel bone. Stress fractures create sharp, pinpoint pain that intensifies with activity and may be accompanied by swelling. Rest doesn't bring the same relief it typically does with plantar fasciitis.
Nerve Entrapment: Tingling and Numbness
In tarsal tunnel syndrome, the posterior tibial nerve becomes compressed as it passes through a narrow channel near the ankle. This causes burning pain, tingling, or numbness that radiates into the heel and arch. Symptoms often worsen at night or after long periods of standing.
Achilles Tendinitis: Pain Higher on the Heel
Although Achilles tendinitis primarily affects the back of the heel and lower calf, it can cause referred pain that feels like discomfort in the heel. Pain typically flares during push-off movements, such as running, jumping, or climbing stairs.
Plantar Fibromatosis: Nodules You Can Feel
This condition causes firm, benign lumps of fibrous tissue to form along the plantar fascia or in the arch of the foot. You can feel these nodules under the skin, and they may become painful when pressed or when walking barefoot. Unlike plantar fasciitis, the abnormal tissue is physically noticeable.
How Our Podiatrist Identifies the Real Problem
Guessing the cause of your heel pain can delay healing and keep you from the activities you enjoy. A thorough evaluation helps identify the true source of the problem and guides the most effective treatment plan.
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Physical examination. Dr. Neibauer begins by assessing your gait, checking for tender areas, and evaluating your foot structure and flexibility.
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Imaging. X-rays help identify fractures, bone spurs, or structural concerns. Ultrasound, instead, offers a real-time look at soft tissue inflammation, tears, or nodules. When additional detail is needed, an MRI can differentiate between conditions that present with similar symptoms.
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Specialized tests. If nerve entrapment is suspected, specific maneuvers can reproduce symptoms and help determine the exact location of compression. Range-of-motion assessments evaluate joint function and highlight restrictions that may contribute to heel pain.
Why Accurate Diagnosis Changes Everything
Treating plantar fasciitis when you have a stress fracture won't help, and it may make things worse. Each condition responds to different interventions, and knowing what's happening inside your heel determines which treatments will provide relief. Alpine Foot & Ankle Clinic offers advanced therapies that speed recovery and reduce pain, such as: