Heel pain is a common complaint we see in the clinic. It can affect all ages and all populations. There are many causes and reasons for heel pain, but the two most common are Achilles Tendopathy or Planter Fascitis. How do you know which one you have? Which one should you treat? The answer is both! Let’s talk about why!
The achilles tendon is made up of the medial and lateral gastrocnemius, soleus, and plantaris. It inserts or attaches into the heel bone or calcaneus and causes plantar flexion or pointing of the toes.The planter fascia is made up of thick connective tissue supporting the arch on the bottom of the foot. It runs from the heel bone or calcaneus to the metatarsal bones in the midfoot.
Through focused questions and physical examination, we are able to determine where your pain is most likely coming from. Achilles Tendopathy typically presents with pain in the tendon on the back of your heel that increases with activity. Planter Fascitis typically presents with pain in the bottom of the foot with the first steps in the morning or after sitting for longer periods of time.
Since the Achilles tendon and the plantar fascia attach on the same bone, the calcaneus, they directly affect one another. When one is tight it can pull on the calcaneus and cause the other one to overwork or tighten and cause pain. You may only experience pain in one, but the other may be tight or dysfunctional as well. We often have people come into the clinic with plantar fasciitis who have a history of Achilles tendinopathy or vice versa.
So, what does this all mean? If you have been diagnosed with either achilles tendinopathy or plantar fasciitis, you need to treat for both. This will help to decrease the risk of recurrence and of developing pain in the other area.
Alvarez-Nemegyei J, Canoso JJ. Heel pain: diagnosis and treatment, step by step. Cleve Clin J Med. 2006;73:465–71. [PubMed]