Reviewed by: Chad Bassi, DPM, FACFAS, FACPM – Podiatry
Pain on the underside of the foot, especially near the heel, is a very common problem. While it can be produced by a number of conditions including, cysts, nerve entrapment, gout, Posterior Tibial Tendon Dysfunction (common in flatfoot), or Tarsal Tunnel Syndrome — two commonly confused causes are plantar fasciitis and calcaneal (heel) stress fracture.
Plantar Fasciitis vs. Heel Stress Fracture
Plantar Fasciitis Definition
Plantar fasciitis involves an inflammation and micro-tearing of the plantar fascia, which is a thick band of tissue that runs along the bottom of your foot between your toes and heel bone. The condition tends to be most painful in the area where the fascia attaches to the heel. It is common in runners, people who wear shoes that don’t provide adequate support and people who are overweight.
Stress Fracture Definition
A stress fracture is a small crack in a bone that is caused by repetitive force rather than a single impact. Heel/calcaneal stress fractures are often the result of overuse, but can also occur in bones that are weak due to conditions like osteoporosis. People who are on their feet for extended periods are more susceptible to heel stress fractures, especially if they carry heavy loads. It is also common for people to develop a stress fracture if they switch rapidly from a sedentary lifestyle to an active one without giving the body time to adjust.
How to Diagnose Your Foot Pain
While you should talk with your doctor if your foot pain is persistent or severe, you may be able to determine what is causing it by paying attention to these indicators:
- If the pain is at its worst with your first few steps in the morning, then lessens as you get moving but returns after you stop, plantar fasciitis is more likely the cause.
- If the pain is more severe as you move but lessens when you stop, a stress fracture may be causing it.
- If you have swelling around the painful area, a stress fracture is more likely.
- If stretching temporarily reduces the pain, it may be the result of plantar fasciitis.
- If squeezing the heel bone (between thumb and fingers on the inside and outside of the heel) causes pain, that may be a sign of a stress fracture.
Plantar Fasciitis & Stress Fracture Treatment Similarities
Plantar fasciitis and stress fractures are different conditions. However, many aspects of their treatment are similar. This includes:
- Reducing or temporarily stopping activity that is contributing to the problem (running, for example)
- Icing the affected area
- Using footwear with better support
- Taking action to improve bone health such as consuming more calcium and vitamin D in your diet
- Achieving and maintaining a healthy weight
- Using anti-inflammatory medication
- Orthotics (supports, shoe inserts, braces or splints)
- Physical therapy
- Steroid injections
- Casting the foot, if necessary (in cases of fracture)
- Surgery, if necessary
Foot Pain Recovery Requires Patience
One of the essential elements for treating both plantar fasciitis and a stress fracture is patience. Reducing swelling, repairing micro-tears and mending bone all take time. A period of six to eight weeks of limited activity may be required for your body to heal. If you need help treating foot pain, find a Baptist Health podiatrist near you.