7 Other Causes of Heel Pain

Plantar fasciitis gets blamed for nearly every sore heel, and much of the time the blame is deserved. But at Abacoa Podiatry & Leg Vein Center, a meaningful share of the patients who arrive with a plantar fasciitis label, often after months of stretching and inserts that did nothing, turn out to have something else entirely. Treating the wrong condition does not just waste time; it can let a stress fracture progress or a nerve problem become permanent.

Here are seven conditions we routinely identify in patients from Jupiter, Palm Beach Gardens, and the surrounding communities, how each one differs from plantar fasciitis, and how we confirm the diagnosis.

1. Achilles Tendinitis and Insertional Achilles Tendinopathy

Location is the giveaway. Plantar fasciitis hurts on the bottom of the heel. Achilles problems hurt at the back of the heel, where the tendon attaches to the bone, or a few inches higher along the tendon itself. Pain is worst with the first steps in the morning, climbing stairs, or pushing off while running, and the back of the heel may be swollen or have a firm bump. Common in runners, weekend athletes, and anyone with tight calves. Treatment focuses on eccentric calf strengthening, heel lifts, MLS Laser Therapy, and EPAT Shockwave, which has excellent evidence for chronic Achilles tendinopathy.

2. Baxter's Nerve Entrapment

Baxter's nerve is a small branch of the tibial nerve that runs along the inner heel beneath the arch. When it is compressed by swollen tissue, a tight muscle, or a heel spur, it produces pain on the inner bottom of the heel that mimics plantar fasciitis almost exactly. The difference is the quality of the pain: burning, tingling, or electric sensations, sometimes radiating toward the arch or outer heel, and often worse at the end of the day rather than first thing in the morning. It is estimated to account for up to twenty percent of chronic heel pain and is frequently missed. We diagnose it by exam and diagnostic ultrasound. Treatment includes offloading, targeted injections, and in persistent cases a minimally invasive nerve release.

3. Calcaneal Stress Fracture

A stress fracture of the heel bone is the diagnosis we least want to miss. It develops from repetitive impact, typically in runners who increased mileage quickly, in military-style training, or in patients with low bone density. The pain is deep, aching, and diffuse rather than pinpoint, it hurts with every step rather than easing as you warm up, and squeezing the heel from both sides reproduces it. Early X-rays are often normal, so we rely on the squeeze test, ultrasound, and MRI when needed. Treatment is strict rest in a walking boot for four to eight weeks. Shockwave, aggressive stretching, or continued running on a stress fracture can turn it into a complete fracture.

4. Heel Fat Pad Atrophy

The heel has a specialized fat pad that absorbs shock with every step. With age, repeated cortisone injections, or years of walking on hard floors, that pad thins and loses its cushioning. The result is a dull, bruised feeling directly in the center of the heel, worse on tile or concrete and better in cushioned shoes. Unlike plantar fasciitis, it is not worse in the morning and stretching does not help. Diagnostic ultrasound measures the pad thickness. Treatment centers on cushioned heel cups, custom orthotics with a deep heel seat, and avoiding barefoot walking. Steroid injections make this condition worse.

5. Sever's Disease in Children and Teens

Heel pain in an active child between roughly eight and fourteen is almost never plantar fasciitis. It is usually Sever's disease, an irritation of the growth plate at the back of the heel caused by the pull of the Achilles tendon during growth spurts. Kids limp after soccer, basketball, or gymnastics and complain of pain on the back or sides of the heel. It resolves completely once the growth plate closes, but in the meantime it responds well to heel lifts, calf stretching, activity modification, and in some cases a short period in a boot. Parents should not wait it out if the child is limping.

6. Haglund's Deformity and Retrocalcaneal Bursitis

Sometimes called pump bump, Haglund's deformity is an enlargement of the bone at the back of the heel that rubs against the heel counter of a shoe. It irritates the Achilles tendon and the bursa beneath it, causing pain, redness, and a visible bump at the back of the heel. Stiff-backed shoes, dress shoes, and skates are the usual triggers. Treatment starts with footwear changes, heel lifts, and laser therapy for the inflamed bursa. Persistent cases can be corrected with a minimally invasive procedure to reshape the bone.

7. Tarsal Tunnel Syndrome and Referred Pain

Tarsal tunnel syndrome is a compression of the tibial nerve behind the inner ankle, similar to carpal tunnel in the wrist. It causes burning, numbness, or shooting pain into the heel and sole, often worse at night. Heel pain can also be referred from the lower back through the S1 nerve root, or be the first sign of an inflammatory condition such as psoriatic arthritis, reactive arthritis, or ankylosing spondylitis, especially when both heels hurt at the same time or the Achilles is swollen. When the exam does not fit a mechanical cause, we look further and coordinate with the right specialist.

How We Tell Them Apart

The diagnostic process is not complicated, but it has to be done. We take a careful history, including when the pain started, what it feels like, and what makes it better or worse. We examine the entire foot, ankle, and calf, not just the sore spot. We obtain digital X-rays in the office to evaluate bone and alignment. We use diagnostic ultrasound to visualize the plantar fascia, Achilles tendon, fat pad, and nerves directly. When the picture is still unclear, we order MRI or nerve studies.

A correct diagnosis at the first visit is the fastest route to a pain-free heel. It also determines which of our advanced treatments, whether MLS Laser Therapy, EPAT Shockwave, PRP, custom orthotics, or a minimally invasive procedure, is actually going to work for you.

Frequently asked questions

Can I have more than one of these at the same time?

Yes. Plantar fasciitis combined with Baxter's nerve entrapment or with fat pad atrophy is common, which is one reason a single treatment sometimes brings only partial relief.

My X-ray showed a heel spur. Is that the problem?

Rarely. Spurs are a sign of long-term tension on the fascia, not the source of pain in most people. A spur on the back of the heel near the Achilles is a different matter and can be relevant.

Why did my cortisone shot not help?

Cortisone treats inflammation. If the pain is from a nerve, a stress fracture, or a thinned fat pad, the injection will not help and in some cases will make it worse.

Should I see a podiatrist or an orthopedist?

A podiatric foot and ankle surgeon treats every condition on this list, has the diagnostic ultrasound and X-ray in the office, and can move from diagnosis to treatment in a single visit.

Is It Really Plantar Fasciitis? 7 Other Causes of Heel Pain a Jupiter Podiatrist Checks For