What If Your Heel Pain Isn’t Plantar Fasciitis and What to Do About It

Stay the CourseNothing ruins a perfectly good runner like plantar fasciitis, the dreaded snake bite of the heel and arch of the foot. In essence, its nasty foot pain–particularly heel pain–that prevents us from running. Once it sets in, is one of the most menacing and stubborn conditions.

Ultrarunners seem particularly prone to heel and arch pain. Both uphill and downhill running stresses the foot: the ups stressing the soft tissues of the plantar arch, and the downhills providing ample pounding for the joints.

It’s okay to call your foot and heel pain plantar fasciitis–just like that Coke at the aid station that might be Pepsi or RC Cola. But be sure that you–and your doctor, PT, chiropractor, LMT or other healthcare helpers–are aware of all of the different sources of foot pain. Awareness is the first step in comprehensive treatment and fast recovery from the dreaded “PF” and its brethren.

Plantar Fasciitis, Defined

The plantar fascia is the thick connective tissue that runs from the base of the heel, to the bones of the forefoot. Collectively, with intrinsic foot and ankle muscles, it supports the arch of the foot and helps transfer energy from the forefoot to the rearfoot and ankle, and up the leg.

By definition, in a truly literal sense, fasciitis is an active inflammation of that tissue.

But is foot and heel pain always plantar fasciitis? In a clinical sense, one can only have fasciitis if an active inflammatory event is occurring. Since inflammation only lasts twenty days, indeed, not everyone with persistent foot pain truly has fasciitis.

Not all tissue paper is Kleenex. Not all lip balm is Chapstick. And so it goes, not all heel and arch pain is plantar fasciitis. But as Shakespeare once said, “Is foot pain by any other name, any less excruciating?”

However, to label all foot pain as plantar fasciitis possibly limits one’s ability to quickly and effectively recover from it. Below are some other, equally common causes of foot pain.

Foot Pain: Differential Diagnosis

There are a many possible sources of persistent heel pain and arch pain. Here are the most common I see, clinically:

Soft tissue sprains and strains. There are several major muscles, tendons, and ligaments that span from the heel and ankle to the toes. Besides the plantar fascia, there are several flexor tendons–of muscles originating on the lower leg–that course their way into the foot. Any number of these tissues can become strained under the load of road and trail running. A review of the Rules of Tissue Loading explains how a plantar surface tissue can become irritated.

However, since soft tissue tends to heal quickly given proper treatment, these causes tend to heal rapidly. Those with persistent heel pain and arch pain–who see me and other medical folks after weeks, months, and even years of pain–tend to have a pain generator of different origins:

Joint Pain. There are over two dozen joints in the foot and ankle complex. With the extreme stress of ultra trail running, these joints could become stiff, irritated, or both.

Joints–articulating surfaces of two bones–require but two things to be happy:

  • Full range of motion
  • Symmetrical, equal loading of surfaces

Seems simple, but running hard and long on uneven surfaces can strip a joint of those two things.

Range of motion loss. Joints get the bulk of their nutrition from range of motion. The vast majority of joints in the body are synovial: two bones surrounded by a leathery capsule filled with fluid. The cartilage surfaces receive very little blood flow. In order to receive nutrition, the joint must “lubricate” itself with the fluid of the joint, absorbing nutrients from the fluid along its surface–via regular, full range of motion.

When joints stop moving through their full range, elements of cartilage do not get this nutrition. The cartilage dries up. And it is replaced with bone. This, by definition is osteoarthritis. Preceding that, is pain.

Asymmetrical loading. Joints have the ability to move–sometimes small amounts in one plane; sometimes substantial amounts in many directions. But when running, joint surfaces are designed to be loaded so that the entire surface of one bone impacts flush against the other. This promotes maximum stability; it also ensures that cartilage receives a steady dose of hydration and nutrients.

Asymmetrical loading occurs as the result of abnormal running surfaces–uneven, rocky trails, or a cambered/slanted road–or with inefficient running mechanics.

And when a joint becomes unhappy, it causes pain. Typically, a painful joint will hurt at its precise point of irritation. But joints of the ankle and foot will frequently refer pain to adjacent areas, out the sides or beneath the point of irritation, at times mimicking soft tissue pain.

How can you tell if you have a soft tissue or joint issue? Below are some comparisons:

Soft Tissue Pain Characteristics

  • Succinct, reproducible, palpable tissue pain. Can you find the one spot that is tender?
  • Pain with active use: when you do a toe curl or use the muscle (absent weightbearing), does it hurt?
  • Pain with passive stretch: is pain produced when you bend back your foot and toes? (again, without weighbearing)
  • Pain with resisted testing: when flexing your foot and toes, is there pain?

Joint Pain Characteristics

  • Dull, diffuse pain: no discernible “tender spot.” Rather, it hops around and you can’t put your finger on it.
  • Pain with weightbearing through the joint.
  • Pain is worst in the morning, after prolonged weightbearing, or after resting, then bearing weight through the joint.
  • Non-weightbearing testing–actively flexing and passively stretching the foot–is pain-free.

If your symptoms align with the joint pain characteristics–and if your foot pain fails to respond to soft tissue plantar fascial treatment approaches–you likely have joint pain.

The three usual joint suspects–the talocrural, the subtalar, and the talonavicular–can all become painful and mimic plantar fascial pain. Each joint lies on the medial plantar surface of the foot, and each is prone to stiffness and asymmetrical loading during running.

Neutral foot - side view

Medial view of a foot and ankle model, identifying three common problems joints for runners.

Above shows a medial view of the foot, showing three main joints of the foot. The talus plays a role in all three: it is the go-between from the foot and leg bones.

From above, it forms the talocrural joint. The main motion for this joint is “up and down”–it allows the toe up/toe down action that occurs in the run stride.

This joint is prime to get stiff, especially with repetitive downhill running: rather than smoothly sliding and gliding, hard downhill trail running can cause jamming forces of the talus into the tibia and fibula. And when this joint gets stiff, it can refer pain in any direction around the talus–front or back of the ankle (mimicking both anterior tibialis tendonitis and Achilles tendonitis, respectively), or it can spit pain out the side–namely the medial ankle and arch.

Between the talus and the calcaneus–or heel bone–is the subtalar joint. It is designed to move in several axes, but its primary axis of motion is medial to lateral. This joint is of little consequence to the healthy, normal runner: minor motions occur depending on the gait cycle. However, deviations or inefficiencies–namely in the foot strike pattern–can cause significant pain emanating from the subtalar joint. Excessive lateral foot strike can cause stressful joint compression to the medial aspect of the joint–mimicking plantar fascial pain!

Neutral foot - rear view

Lastly is the talonavicular joint. This joint is the primary conduit from the fore and midfoot to the ankle and leg. The navicular bone is the “keystone” of the arch. Stiffness or irritation here can also cause significant arch pain.

The following are some illustrations of how mechanical forces can cause joint and soft tissue pain:

Foot and shoe position during pronation

Over-pronation, as shown with shoe and joint model.

Pronation + arch collapse - side

Medial view of a collapsed arch.

Excessive medial foot landing leads to over-stressing of the medial arch, or “arch collapse.” This stresses all tissues of the plantar surface and is the primary etiology of true plantar fascial pain.

Equally common, especially for faster trail runners, is excessive lateral foot strike:

Supination - shoe a foot - rear view

Excessive lateral foot strike/supination, as shown with a shoe and joint model.

Foot supination - rear view

Excessive lateral striking significantly compresses the medial joint surface of the subtalar joint. This compression accounts for a large percentage of non-plantar fascial foot pain cases. It refers pain at its site, but also farther down into the arch and along the heel bone.

Too much lateral strike can also cause plantar fascial torqueing: the heel rotating to the right (in the above picture), but the forefoot rotates to the left as it contacts the ground – adding a twisting force to the fascia.

Nerve pain. Perhaps the most unrecognized and overlooked factor in heel and foot pain is nerve pain. The peripheral nerves of the ankle and foot originate in the brain, course through the spine, exit the low back and pelvis, and must course–fluidly–through the soft tissues of the entire leg.

Repetitive impact forces from running–often combined with compromised spine posture from running all day (or, in our normal lives, sitting)–can cause these nerves to develop “hitches.” This is a concept called nerve tension.

Nerve tension accumulates in the spine and legs with age, injury history, and running volume. When nerves lose mobility, they begin to create pain–often very similar to soft tissue or joint pain, including plantar foot pain.

And because the same repetitive or excessive impact forces that create joint and soft tissue pain also create nerve tension, it is very common for a runner to present with both joint/soft tissue and nerve pain overlay at the same time.

Almost every runner (and most other folks) has some degree of nerve tension. Here’s a test:

Sit with your back against a chair, head and shoulders upright. Extend your knees straight, with toes up. Note the degree of “stretch” in the back of your legs. Then, slump your head and shoulders. Any increase in stretch sensation is nerve tension from tensing the nerve at the head and neck.

Nerve Pain Characteristics

  • Pain at rest–the hallmark sign of nerve pain overlay: do you have any symptoms in your foot when at rest, namely sitting (specifically, with prolonged sitting, long after you’ve stood on it)?
  • Symptoms described as burning, buzzing, or dull aching.
  • Other symptoms higher up the leg, specifically: lumbar, buttock, posterior thigh, calf or shin pain.

Very often, a runner who applies soft tissue or joint treatment concepts will get partially better, but fail to fully recover because they fail to address the nerve tension component.

Runners and clinicians, alike, need to recognize the existence of nerve tension and treat it concurrent with any soft tissue or joint irritation.

Treatment Approaches

Please discuss any of the following treatment approaches with your doctor, physical therapist, or chiropractor before performing.

Soft tissue

These are straightforward because everyone who [thinks they have] PF does them:

  • Rest, ice, soft tissue mobilization, stretch, strengthen.

Real, actual soft tissue plantar pain will heal rapidly, given correct doses of the treatments above. Those who do not respond to that approach likely have a joint or nerve issue.

Joint pain

The two treatment approaches to joint pain in the foot include full restoration of joint range of motion and symmetrical loading.

Range of motion restoration

Ankle dorsiflexion. Normal ankle dorsiflexion is about 20-30 degrees beyond a 90-degree bend at the ankle. If you cannot stretch this far–or if you have symptoms in front, or anywhere around the ankle joint–your symptoms might be due to stiffness there. To mobilize a stiff talocrural joint, try the following:

Perform a standard calf stretch, with a few minor adjustments: be sure your stretch foot is perfectly straight ahead. Keep the foot flat, lean forward with a straight knee until full tension. Then, slowly bend the knee as much as possible without allowing the heel to rise. Slowly oscillate between bent and straight knee. This mobilizes the tibia and fibula over the talus, restoring motion to this joint.

wall stretch ankle straight

Wall ankle stretch – straight knee.

wall stretch - ankle bent

Wall ankle stretch: bent knee. Keep the heel as flat as possible.

Subtalar inversion and eversion. A normal heel bone should be able to “wiggle” about 10-20 degrees side to side. To self-test, cross your ankle over opposite knee. Grasping hold of your ankle with one hand, drive firmly downward with your opposite hand on the inside of your heel bone. Can you move it, at all? If not, and you have heel and arch pain on the bottom/medial side of your foot, your symptoms may be coming from stiff subtalar joint.

To self-mobilize, perform the maneuver described above with firm, slow, on-and-off downward pressure. The degree of motion will be slight, but the potential for pain relief is substantial when motion is restored here.

subtalar mobility

The author applying a straight-downward pressure to the heel bone, stabilizing at the ankle. A normal heel will “wiggle” a few millimeters in both up and down directions.

Midfoot arch. A normal midfoot will have some degree of give, both to the hands and when standing on it. In standing, a normally mobile foot should “sink” a few millimeters to the floor.

Shoe orthotics are intended for those who are hypermobile in their arch: their arch joints are excessively flexible, and the arch “collapses” (typically defined as one centimeter or more) in weightbearing.

However, far more often than not, runners have hypomobile arches–they simply don’t move enough. These folks typically respond poorly to orthotics (often with no improvement, and sometimes they worsen pain).

A hypomobile, stiff arch will benefit from self-mobilization. If you have symptoms that originate farther down the foot, near the apex of the arch–and your foot lacks any give in standing–try the following mobilization:

Stand with stiff foot down. Place your opposite heel directly on top of the stiffest area–typically the navicular bone, which lies directly in front of the tibia-fibula complex. Gently, then progressive bear down with substantial weight onto the navicular. This may seem scary–test it first. A stiff navicular will give very little, even with full pressure. Pain usually comes from skin compression. “Stomp” on and off 10-20 times. Perform before and after running, and/or in the morning, when stiff joints tend to be stiffest.

midfoot mobility

The author, performing a mid-foot self-mobilization in standing. Try with soft-heeled shoes on, if too sore with direct skin contact.

Joint Loading Factors

Loading the joint equally is vital to joint happiness. Orthotics can be helpful for those with hypermobile feet, as they can prevent arch collapse. They are also helpful for slower runners with shorter stride lengths. A short stride tends to include excessive vertical forces (up and down motion). This vertical loading bears down on the medial arch–beyond the capability of muscles, tendons, and the plantar fascia to support it. An orthotic can aid in sustaining the arch. But ultimately, an efficient stride that emphasizes normal hip mobility with greater forward momentum is most important in preventing arch collapse.

Other important factors for symmetrical, low-stress loading include the position and angle of foot strike. The foot should always land as close to directly beneath one’s center of mass as possible. A foot that strikes in front, tends to strike:

  • On the heel;
  • On the outside edge of the foot (heel or midfoot); or
  • On the mid or forefoot, laterally-biased.

A heel strike creates considerable stiffness through the talocrural and subtalar joints. A lateral strike might cause asymmetrical loading of the subtalar joint, and/or a twisting, torqueing force through the midfoot and plantar fascia (see photo above). A midfoot or forefoot strike–significantly ahead of the body–will stress out those joints or strain the plantar fascia.

The most simple, sustainable and important way to correct a foot strike issue is addressing it proximally with:

  • Proper forward trunk engagement, and
  • Moving the hips such that the foot is “pulled” beneath the body

After ensuring proper foot placement beneath the trunk, shoot for a whole-foot strike, where all elements of the foot are absorbing and sharing impact forces.

Nerve Pain Treatment

To treat nerve tension, refer to the test above, except make one slight adjustment:

Sit in a chair, slumped forward. Slowly extend the affected leg with toes up. As the foot and lower leg rise, slowly extend your head at the same speed. The degree of stretch should be significantly less, but still present. Hold one second, then slowly lower. This is referred to as a “nerve floss” exercise: the head gives the nerve slack that is taken by the foot, and vice versa. Repeat ten to twenty times, and perform three to four times a day, especially before and after running. Here is a video link for the exercise.

Call for Comments (from Bryon)

  • Have you suffered from heel pain, plantar fasciitis, or other foot pain?
  • How did you heal your plantar fasciitis, heel pain, or other foot pain?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 161 comments

  1. Carol

    Thanks for the great article. I have been dealing with plantar fasciitis since March 2012. It had gotten so painful I gave up running all together Jan 2013. I have seen two podiatrists, one ortho foot /ankle doctor, and two physical therapists. I have had stiffness in my ankles for a year and a half now. Nothing helped until I read your article. I spent about 2-3 minute one evening doing the ankle dorsiflexion stretches for the talocrural joint and got immediate relief!!! It was like a miracle!!!! A year and a half of stiffness – gone. It has been three days since I did the stretch and still no stiffness. I feel like the fluid in the joint was finally released!

    Now I have a new problem – went to a new physical therapist yesterday for an eval to see if there was a biomechanical reason for my PF. My symptoms of heal pain have greatly resolved and I want to start running again. He did a quick exam of me and said my right hip was higher than my left and I had no movement in my sacroiliac joint. This was why I had PF. He examined me with my shirt still on by placing his hands around my waist and by pressing on my lower back. Then while I laid on the table, he pressed up on my sacrum and down on my right and left ileum for about 20-30 minutes to “get movement” in the joint. He was happy when he saw my hips freely move up and down. Twelve hours later I was in severe pain, unable to sit, unable to lay flat. I am taking 800mg ibuprofen every six hours and am still in pain. Looking on the internet I see that this joint is really not supposed to move very much and usually these manipulations are done in people with back pain from traumas to the buttocks region. I have never had back pain until now. I am afraid I am now stuck with both PF and SIJ pain. Can please help me understand if there is any PT rationale for what he did? Is there a link between SIJ and PF?

    1. OOJ


      A SIJ issue can cause PF by altering how the foot strikes (and pushes off) when walking. Your treatment was warranted, but likely too much (there is such a thing as too much of the right medicine). Contact your PT to discuss the outcome, and adjust your plan of care, accordingly.

  2. John

    Hi – I developed light heel pain about 3 months ago and carried on running for about 2 months making sure i iced regularly. I was running fine and thought that i was putting the issue behind me but after one week the pain become unbearable and i was not even able to properly flex my foot. It has been aobut 1 month since then and i initally tried to carry on running with no success. The main question i have is that i am struggling to diagnose the injury. I have seen a PT last week and he said that if i had plantar fasciitis than i would have experienced pain when he flexed my foot which i didnt. I have rested for one week and the pain does subside but can feel slight pain when my foot is flat on the ground and the heel is weight bearing. Any ideas what this could be and when i can start back running?

    1. John

      Oh I forgot to mention that the pain can be pretty much all over the heel. There is definitely pain towards to inner heel which is why i thuoght it was plantar fasciitis but there is also pain in the middle of the heel and towards the back.

      Any help would be massively appreciated!

      Thanks !!

      1. OOJ


        Thanks for the post. It's impossible to diagnose what's going on with your foot, and this article highlights the multiple factors involved (muscle/tendon, joint, nerve, etc.).

        *Assuming* that there is no pathology, and that it is a mere strain, I will commonly recommend shallow-water running for folks to re-introduce running stress with 50% less load. Try running for ten minutes in waist-deep water: real running, impacting the pool bottom.

        However, I would continue to work with the PT and/or other practitioner so they can resolve any pathological issues, should they exist.

        Good luck!

  3. Kevin

    Joe, great article, one of the only i could find which talk about a diagnosis of heel pain other than plantar fasciitis. I told myself I would only look to the internet as a last resort and alas here I am. I'm still not sure though, the only thing that would make sense for me perhaps is the joint pain.

    I started having heel pain about 3 years ago, at 23 years when I started working full time at my job in the summer. Eventually I was referred to a podiatrist who diagnosed me with plantar fasciitis. Went to therapy, have custom insoles, did the cortisone shots, compound creams, did the icing and calf/plantar stretches, nothing helped. So he suggested traditional surgery. I went to a 2nd podiatrist and went through the same thing, nothing worked and he recommended endoscopic surgery which I did. Took a month off work but it did not work at all, my pain is in fact worse than it was before the surgery. I still can't play basketball/run like I at least could attempt to before the surgery. And now he's recommending shockwave therapy which I'm not sure I should go through with.

    My symptoms were also a bit different than most. I have no heel pain when I wake up in the morning or if I'm sitting/in bed. It was always after standing for a long time at work that caused the pain. Standing is the real killer, although walking hurts as well. I'm not able to quit my job or else that would at least solve the intense pain I experience.

    Could it be joint pain or something else?

  4. vasu

    Hi Joe,

    Great article. I am 50 years old and always been a runner myself. not competitive but keeping health runner at least 40 minutes a day.

    Suddenly i got this arch pain 3 months ago. Unable to run and tried cushion soles. I will try your shallow water running. I am frustrated all of a sudden and unable to shake the pain off.


  5. A.L

    I Have been having pain in my heels near the arch since nov 2012 I was told it was PA after anti inflammatory and 12 weeks time twice a week physio therapy with no success I went back to the doctor and demanded further testing only to find out the reason it is was not completely going away with the extensive therapy at home and at physio was because I have Rheumatoid Arthritis so I am now waiting to see a specialist

  6. OOJ


    Thanks for the comment.

    You are complicated.

    "Chronic pain" is considered any injury lasting more than six months. Yours is three years.

    Refer to my posts on the injury process. Initial injuries are typically "abnormal force on normal tissue": your foot was fine, then you did too much.

    When pain persists for months and years, the pain physiology changes: your tissue becomes abnormal, such that normal loads cause pain/injury:

    – You have pain

    – You do less

    – You get weaker

    – You get stiffer

    – You compensate and walk abnormally

    – You have more pain…

    …and the cycle continues, a downward spiral.

    Your case will take a comprehensive, pain-control and tissue-tolerance-centered approach. No drug, surgery, or singular exercise will do it.

    It is coaching. For example: you used to "run ten miles a day". No you can only run 1/10th of a mile. So what is going to happen if you continue to try to run 10 miles, each day? Or even 5?

    What needs to happen with any injury process:

    – Restore full range of motion

    – Maximize strength: strong, supportive muscles

    – Be normal: stand and walk efficiently, no compensating

    – Pain control: when you reach your tissue tolerance, you must rest.

    Until those things occur, your pain will continue, regardless of surgery, waves of shock, or anything else. This is also why simply "taking a month off work" was ineffective.

    Good luck!

    Initial injury posts:

    Part 1: https://www.irunfar.com/2012/03/anatomy-of-a-runni
    Part 2: https://www.irunfar.com/2012/03/anatomy-of-a-runni

  7. Allison

    I just developed a sudden dull ache in my right heel about a day and a half ago and it will not go away. It is at the front of my heel bone right before my arch begins. It hasn't gotten worse, but it still concerns me a little bit. It first began on Wednesday night while I was sitting down (go figure). My heel just felt a little strange…I can't really describe it. But when I stood up and began walking around, it began aching. I ran Wednesday morning and had no problems with my heel. I've never had any issues with my feet at all before this. I did actually run yesterday (Thursday) morning as well. While I initially felt the dull, mild aching for a little bit, it eventually subsided completely during the rest of the run. It did return afterwards, though. Today, the situation still remains the same. It has not worsened, but there is still just a little bit of a nagging ache when I walk and when I apply pressure with my fingers. Does anyone have an idea of what this might be? Thanks in advance!

  8. Genelle

    I have had chronic pain in my heels for years now. The longer I stand on them the more painful they become. Eventually they become so painful I have moments where it feels like someone is stabbing a needle into my heel. Orthotics have helped but not fixed the problem. I also get inflammation and use ice packs. Xrays do not show anything. My solution to the problem has simply been to not use my feet! Barefoot I can stand for 10-30min. With Orthotics 2-3hrs depending how much I move around. I know there is no solution but at least I feel a bit better being able to tell my problem. The worst problem is that there is no visible sign of a problem and no diagnosis so most people don’t believe me.

  9. MarchantvW

    i fell from about roof height and put all the pressure on my heels. 1 week later i could not sleep on my back because my heels touching the mattress was too painful. i got xrays at the hospital. The doctor told me i had severe heel bruising and would get better in around 3 months. during the next 5 months i had to walk on my toes because my heels were too painful.. A YEAR LATER i could walk better but not normally, i was putting weight onto other parts of my feet. My heels feel like they are made out of glass or something like that. IT HAS BEEN 2 AND A HALF YEARS NOW. i have worked part time during this, so i have had plenty of time to rest. but this year i did a full time week and had to walk around everyday or just be standing. The pain got even worse. it went from being painful to unbearable. it feels like my feet are burning all the time. while my heels are touching nothing its quite comfortable. resting on my bed gets uncomfortable while my heels are touching the mattress. Walking around drains my energy quickly (because its painful) and the pain keeps increasing while im standing. theres been days that iv had to sit down on the ground because i cant take the pain any more. after resting for about an hour the burning sensation will go down but my feet feel uncomfortable. i went to a FOOT MECHANIC, he said that iv been walking wrong this whole time and i need to learn to walk again. he can make me a sole for my shoe that would help me put pressure on the right places of my feet while i walk. Other then that he said he doesn't know what the problem is. Should i get the sole ? its expensive ! and even just wearing shoes is uncomfortable because they are tight around my feet and it starts to hurt.
    Yesterday i went to a FOOT SPECIALIST. i told him my whole story and straight away he said he cant help because it sounds like a CHRONIC PAIN problem. He said thers nothing wrong with the structure of my feet. He is sending me to a CHRONIC PAIN DOCTOR. He did not ask me any questions. (was expecting some help) Is there anything else i can do ? would an MRI help ? im 24 years old.. thanks for reading.

    1. 00joeuhan

      Thanks for the message, and sorry to hear about your foot pain.

      Pain – especially *trauma* is a "soup of many ingredients". When you have trauma like that, you not only stress bone, muscle, tendon, and ligament, but joint surfaces (cartilage).

      And nerves.

      My impression – based on your symptoms – is that you may have some nerve irritation, entrapment, or "damage" (scary word, but nerves WILL heal of treated correctly). The trauma of your incident is MORE than enough to cause nerve irritation that – unless treated – will not go away.

      I strong consider you see a physical therapist with advance manual therapy certification:

      North American Institute (http://www.naiomt.com/index.cfm?fuseaction=Page.ViewPage&pageId=491)
      Institute of Physical Art (http://www.instituteofphysicalart.com/ipa/referral/list)

      I am closely affiliated with the IPA, but both groups are highly specialized with advanced training.

      Consult one of these folks (even if it requires a long drive and more $$), tell your story, and mention that you may have some nerve involvement.

      Good luck,

  10. anikobodor

    Continuation 1:

    I had an MRI done and it shows a muscle cyst (10*20*20mm) below the felxor hallucis longus that occupies the cranial part of the musculus quadratus plantae, protruding into the lateral part of calcaneous and based on the report it is possible that it presses on the areas where the plantar nerve passes. When receiving this report I was delighted and though that finally the cause was discovered and by removing the cyst I can go back dancing and live an active life again. Yet the orthopedic surgeon I went to see is not keen to put me in surgery and said that I'd be better off with conservative treatment. Now I wonder if I failed to improve as much during the past 4-5 years as to be able to resume running/dancing can he be right? Or does a surgery of removing the cyst impose so much risk of hurting the surrounding tissues/nerves?
    Perhaps I shoud go and seek a second opinion.
    What do you think?

  11. anikobodor

    Continuation 2:

    I tested my symptoms based on the criteria in your article, and I do not get the morning stiffness at all (so I guess my problem is not PF also because the stretches never helped), I notice some immobility and pain when doing the wall ankle strech (joints implicated?), when it is bad then I have a dull pain in the heel that sometimes gives a burning sensation too, and I tend to have pain through the arch with stiffness in the calf despite appropriate warm-up before and stretching after exercise (nerve is pressed?). I wear arch support since that injury but to be honest i think it makes my feet pronate even more than natural because the medial part is pretty high and the lateral shows no elevation at all. I really don't know what to do next and how to get my foot health back to be able to dance again.
    Thanks everyone for any ideas or advice!

  12. anikobodor

    Part 1:

    Dear Joe,
    Just came across your article and have been reading some of the posts too. Great summary and really helpful for those stuggling with heel pain that doesn't seem to subside.
    I'm however still rather clueless regarding what would work for me.
    I was a ballroom dancer and some years ago I had an injury, dancing in high heels and all of a sudden I felt a sharp pain and couldn't stand on my foot anymore. It swell, got red, and I was in sharp pain for about 3 weeks. I went to see orthopedist specialists who sent me away with the diagnosis of plantar fascitis, recommended rest, icing, etc. It eventually did become better, I can live a normal life, have limitations though in doing sports. I can hike in well supporting boots for example but cannot run and could take up ballroom dancing again. If I give running or dancing a try, even if in falt shoes or with very small heel the pain comes back. It does not hurt when doing the actual exercise but it comes usually the day after or past two days and lasts for 1-2 weeks.

    1. 00joeuhan

      Thanks for the comment, and sorry to hear about your foot pain.

      To address your situation, you need to take a step back and consider some injury concepts discussed here (https://www.irunfar.com/2012/03/anatomy-of-a-running-injury-part-1.html):

      – Your injury was likely created through "abnormal forces on normal tissue". You *were* fine until you went dancing (abnormal forces).

      – Your ongoing dysfunction is now "normal forces on abnormal tissue". Your tissue may be abnormal because:

      — the tissue (muscles, tendons) is weak
      — joints are stiff and/or mal-aligned
      — overall "tissue tolerance" is low

      That said, when you try to lead a normal life (light jogging, light dancing, flat/slight heeled shoes), it flares.

      Consider finding a good "pain manager" — someone who can help you make your tissue as normal as possible, then devising a plan to gradual load the tissue and "get it in shape" again!

      Good luck!

  13. Gavshirt

    Hi Joe, great article.

    I was wondering if you could help/advise. I am getting a sharp needle type pain on the outside of my right heel about 1/2 inch from where the heel meets the floor (towards the rear), I get it when I straighten and raise my leg (approx 30-40 degrees) and pull my toes toward my body – it feels like something is tearing just underneath the skin.
    If I continue the pain subsides but this would leave the area feeling slightly numb and a dull ache for the next hour or so.
    I get the same steeling but a lot milder in the left foot.
    The sypmtoms started approx six weeks ago and is slowly getting worse.

    I had a discectomy on L5/S1 in march 2013 so my initial thought was nerve tension, but the fact it is in both feet made me think twice.

    I have tried the nerve tension excercise (slump test) and lifting my head back or slumped forward has no effect at all on the pain. I wondered if its possible that a nerve is pinched in the foot?
    I can pull my toes up with a bent leg with no pain or unusual feeling at all but as soon as the leg gets nearly straight it starts.

    I brought a new pair of shoes approx two week weeks before I noticed anything – could this be the cause? As its the only thing I can think of that could effect both feet.

    Someone recommended deep tissue massage on my legs as I do have quite tight hamstrings/calves/Achilles!

    Have you ever come across this before? Any help from anyone would be great as I have been given conflicting treatment advice and don't want to do anything to make this worse.



    1. Craig

      Hi Gavin, I have similar symtoms and the same history as you regarding L5-S1. Did you ever get to the bottom of your issues?


  14. ricky

    Hi joe
    good article covered almost everything. But what I m suffering is pain in heel only if I stand for say 10 minutes which onsets from 5 minutes ..pain depletes if I rest.no pain when I wake in morning ..but the pain gradually builds up during the day, im nt an athlete

  15. Georg535

    I've had Plantar Fasciitis in both feet and I couldn’t seem to find any relief from the pain. I took 5 shockwave therapies till now and have been stretching exercising and putting night split, ice rolling, shoes. And I couldn’t even walk without pain. I’ve been using MEDICOVI Twin-heels ( http://www.medicovi.com ) orthopedic insoles. New technology has opened up possibilities for this effective form of orthopaedic relief that combines movement with dynamic pressure relief. This new technology counteracts the negative effects that our modern way of life has on our bodies, while providing instant relief for heel pain and foot pain caused by heel spur and plantar fasciitis. One of the biggest problems of our modern lifestyles is a lack of movement of the foot and the motor system, and it is a key reason that doctors advise patients to exercise and move more frequently. I’ve been using theese for months now and I’ve just bought my second pair. I’ve always suffered from pain in my feet, especially around the heels. Since owning these my life has literally changed. I can now walk & run with a smile on face. Can’t recommend them highly enough.

  16. danielflucke

    Thanks for all the information here. The bone joint pictures are really helpful. I've also heard about treating foot pain with infrared heat with something like one of these. Do you think that would help with a sore heal?

  17. Leslie4110

    Hi Joe,__I am so glad I found your article – what great info!__From your information, I believe I have subtalar joint paid and not PF after all. I will do the ROM heel stretch you illustrated several times a day – what else can I do? Do you recommend heat and/or ice, rest from running, anti-inflammatories, etc? If so, how much/how often? I have a lot of inflammation and pain. __Also, unfortunately, I have been dealing with this at different levels for probably 4 years and I know I have some scar tissue on the outside of my heel. Is it possible that wearing stability running shoes when I was actually a netral runner might have caused this problem to begin with?__Dare I hope that proper treatment and neutral shoes might be the ticket for me to be able to run in the future?__Thanks so much for any help! :)

  18. Jennifer Sphar

    Thank you for sharing this information as it is really hard finding information on heel pain that is not PF. So here is my story. I have always had high arches. About two years ago, my mom and I decided to start doing a couch to 5K for fun. I have never been a runner because I hurt my left knee while dancing in high school. So I went to get some good shoes and they told me I have over-pronation. I have dealt with arch/heel pain on and off for the last couple years. Well about 4 months ago I started teaching dance and I dance barefoot. My pain has gotten worse so I went to a specialist yesterday. He did an ultrasound on my feet and found my right foot plantar fascia was inflamed but not to the point of plantar fasciitis. And my left foot was really inflamed labeling it with plantar fasciitis. I have never had the pain in the morning like most with PF typically just after a long day of being on my feet. Sometimes its so bad it hurts to stand. So he gave me a prescription of an anti-inflammatory and taped my feet. He said I should notice immediate relief from the taping. It was to support my arch and stop that legitimate from moving too much. After about 30 minutes of having the tape on I started getting pain in both feet. From the ball of my foot through to the back of my heel. It just got worse and worse so I called the doctor and they said to remove the tape. They have never had anyone have the pain get worse. whatever the tape did, it increased the pain to where I can barely walk today. They started me on a steroid today. I’m beginning to wonder if it’s not PF. Any suggestions on where to start or should I just play out the steroids and see how I do?

    Thank you

  19. Susan

    Hi all, I have been dealing w/ “PF” for the past six years I have had two surgeries after the first surgery the pain got worse. I’ve had numerous Cortizone injections after each injection the pain got worse. I have custom orthotics that makes the pain worse. Shoes that touched my arch make the pain worse. I just went two days ago and had a sympathetic nerve block, and turns out I have complex regional pain syndrome. My leg and foot got really warm and the pain went away. But that is just a diagnostic test with subsequent spinal blocks that should help reset my sympathetic nervous system and hopefully get rid of this PF pain that I’ve been having; because now it’s in both feet now. I have been to 9 podiatrists, 2 foot/ankle ortho Dr.s, 2 neurologists, and 7 physical therapists. The thing that tipped off the last Dr. To send me to an anesthesiologist was that when my feet and legs are exposed they get real cold and blotchy. My toes get freezing and sometimes turn colors. I was very close to having the fascia cut on my right foot. So maybe if your feet feel trapped in shoes and things hurt your arches, along with cold/ hot feelings then maybe it could be this CRPS thing. I really hope these blocks work for me because I really want to walk/run/ work again!

  20. Alden

    Went to a western doctor, said it was a strain or tendonitis….gave me meds, they did nothing over a month….

    Then went to a eastern medicine practitioner….they did accupunture and diagnosed a compressed nerve and chi blockage below my knee, did theraputic massage….I was better in 3 days.

    Screw western medicine, its all drugs and wait

  21. Sofia Cook

    I’m pretty sure I don’t have PF, but found this site trying to understand a recent problem, I have not felt before. After 2 months away with minimal exercise, I returned to my fitness yoga class and mostly performed as before except for a sharp nerve (I assume) pain at the back of my left heel when I tried to push it flat on downface position. This has never been experienced before. Any other position is fine and in normal walking & life I have no pain. I have tested it a few times over the past week & experience the same shooting pain whenever I try to push my left heel back (acute angle of foot to leg) and it seemed worse this morning back at my fitness yoga class. Any suggestions as to what it may be and how I should treat it – ie exercise or rest? None of the information nor illustrations on heel pain seem to show pain in this area.

    1. Brock

      I’m curious if you ever found any info on this? I have the pain you’re describing and I cannot find anything online, yet, that addresses this issue. It’s also in my left back edge heel bone area and feels totally fine with most running and day to day movement. It’s only when I do that acute stretch that it really hurts. Like a shooting burning pain. I haven’t completely nailed it down as to the perfect stretch position that causes it, just know that when my toes and shin get closer together, even more so my toes pointed to the left side of my shin versus right side when doing this acute angle (knee facing 12 o’clock, toes 10, heel 4 in acute angle position)…that’s when I feel it. Very bizarre. I don’t run a lot, but I do. I did practice martial arts for a couples years very consistently, then got out, and wondering if I pulled something when doing some higher kicking bag work not stretching enough or something and maybe a quick pull or small tear. Anyway, just sharing. Maybe you found something out?

      1. Andy

        Hi, I do kickboxing and Fran a week ago I have exactly same problem. Recommended stretches don’t do the job at all have you found out what it is, or how you felt with it? I’m fighting in 3 weeks and this is scary, can’t do a front kick…

  22. Jessica

    Almost 2 years ago to the day I started having pain in my arch. I had been running on a regular basis for a few months and had just ran about 3 miles.

    I was told by my doctor that I needed to lose weight by walking. When I went in, she asked me why I wasn’t walking faster. I explained that my hip flexors were limiting my ability to have a longer stride. She dismissed this and told me I needed to walk faster.

    Instead I decided to start running. I knew my weight would increase my chances of injury, but running didn’t hurt as much as walking and I felt like I was doing well.

    So the day I hurt my foot was the last day I ran. The pain steadily go worse over the next few months to the point where I could barely walk. I finally decided it was time to go see the doctor. This time, thanks to the turnover at the VA, it was a different doctor. Since I have fibromyalgia, I wasn’t sure if it was that or an actual injury, so that is why I took so long to go in. The doctor gave me a consult to podiatry.

    The podiatrist diagnosed it as PF and gave me a shot of cortisone and stretches to do. Over the last year and a half I have had 3 injections (I wait until I’m barely able to walk to go back in) and have done the stretching and orthotics. This last time she said we would have to talk about surgery if it didn’t work.

    I had been reading a lot up on it and decided to ask her if there was any way it could be something else. The reason was because the stretches felt unnecessary although I did them and it wasn’t getting better. My right foot is highly flexible as well as my calf. I do have problems with my back and my gait. She proceeds to tell me that she was certain because the shots gave me relief for a period of time.

    While I don’t want to question my doctor, I felt that seemed a little weird considering a lot of what I’ve read has said that PF isn’t an inflammatory issue (they did biopsies and found no inflammation in people with PF) and the only test done was an x-ray. Added to that my flexibility and lack of pain with stretching it just seems wrong that this issue would persist.

    I have had days where it hurts, but overall I isn’t bad again yet. How should I approach the subject with the podiatrist since she is so sure?

    1. Chris

      It’s just sad when the patient does such a great job of describing their issues but then have to face close-minded physicians who are stuck with tunnel vision on the things they normally see and have a hard time looking past the everyday issues. I’ve always seen & believed that the best physicians are those that actually take the time to listen to their patients. I do take into consideration the many patients who over analyze and/or over diagnose themselves, but when you’re out here scowering the internet looking for answers & solutions, all we really want is for our doctors to actually listen to us.

  23. Anne

    It has been over a year that I have had pf issues in my left foot. I have been to orthopedic and went to pt and didn’t change. Then went to podiatrist who gave me a cortisone shot that lasted only 3 weeks. I had Mri on foot and also mri on lower back. I have lower back pain that goes down my left leg and calf. I really believe the pf pain I get has something to do with back. If I get pain in pf driving and rub my thighs and calf the pf pain goes away. Mri result came back with slight disc pronation and orthopedic said to get a cortisone shot in back which should help the leg pain that radiates. I think I’m going to try and get cortisone as I’m desperate at this point. I’ve been going to pt and acupuncturist weekly for a couple months now with little change. I do get some relief but once I walk a couple miles my pf kills. I’m in my mid 40’s and want to get back to gym and get active again. The pf really limits me and feel like an old lady as just walking kills. Do you have any advice? Am I seeing the right doctor? Do I need to go back to foot doc or stay with orthopedic physiatrist ? I just feel like he isn’t listening about my pf pain as he thinks it’s a totally different issue from my back but I disagree. Do you think the lumbar cortisone injection will help? Any advice would be really appreciate. Thank you

    1. rose

      Anne read below if you have time..I’m long winded when I see hope for relief…But our pain sounds very similar. I don’t know if I in fact have pf. I do believe it is a joint issue/chain reaction affecting arch, fascia and so on and so on upward. I just know this article helped me get almost immediate understanding and some relief already. One thing I didn’t mention below..I was blessed with an extra lower lumbar vertebrae, hence a protruding disc acquired during child bearing years I think..Whether it’s the root of any probs I do not know..Time will tell. My oldest doc sis out of 7 of us, me being youngest has an extra also. Wish I had inherited the brains..she kept them for herself lol j/k ~~~~ Sorry Joe Uhan for multiple posts but thank you again ~~~~ Prayers Anne for answers and relief!!

  24. rose

    I can’not even begin to say how thankful I am to have found this site via Pinterest. I have inner ankle horrible pain, and love to live in my comfortable supportive tennies…right up until bed time. I just had such a eureka moment. My doc took an xray, saw nothing wrong and wrote me a script for pt without much of an explanation of what may be wrong. My symptoms are exact to the TEEEEEEE Thank you thank you soooooo very much!!! Let the healing begin…BIG SIGH!!!! No time to be hurting soooo badly. I am up and down stair all day.

  25. rose

    I will look at the stretches and USE them!! I was so excited to find this I had to go tell my husband. Just sitting there talking to him, I started stretching my foot in the opposite direction, and already relieved some of the pain and tension. Will be doing proactive strengthening exercises, not habitually sitting with my feet turned in, getting inserts for my shoes to offer better support in my not so supportive shoes…and sadly..no more reg. flip flops :( This ankle pain resurfaced after my foot slipped from one basement step to another. Jarred it bad, but took a deep breath and kept going. Up until now, I had forgotten about my senior year volleyball tryouts injury when I ruptured my fascia. We were just doing hand touches over the net and the girl I was opposite of came down with her foot under net on my side and that was the end of that :( and that night I believe it was, a pocket of blood the size of a silver dollar maybe, pooled up in my inner arch and throbbed painfully for I don’t know how long. Was pretty awful, and didn’t even think about it sneaking back up on me to cause potential issues one day(if it in fact is related to my current issue) Not to mention multiple other times I had rolled my ankles which usually resulted in a painful sprain. I am not a runner (wish I could) due to to extremely hereditary knee problems (multiple dislocations of the patella both knees due to, shallow sulcus angle knee..Q Knee?), and looser ligaments than the average person I was told once due to European descent, which I’m not sure how true that is) PT helped, sciatic etc..Our family really didn’t fair well structurally which has caused pain earlier in life than normal and continues unfortunately to my children :( My daughter runs despite her knee probs..&It will catch up to her. Regardless, I am moving all day and refuse to let it keep me down..I do use an elliptical and walk for exercise..that’s about it. Sorry so very long, just excited and super grateful for even a pinch of pain relief which I’m sure you and your readers understand. The feet are so important as I am learning the older I get, now 45. This was throwing my hips off it was so bad and embarrassingly, got worse after the holiday snuck an extra 10ish lbs into my back pocket lol ehh sigh :( Supportive shoes helped but this is a eureka moment for me and wish I’d discovered it sooner. I can’t thank you enough!!! Again I do apologize this is sooo long. Please forgive my excessive excitement lol

  26. Scott

    I’ve had heel pain since oct 16, started off as a heel spur that is now no longer the issue, I have sharp pain on the inner part of heel and at the back as well as I step, landing is ok it’s the taking off when the pain occurs I have not been able to do any significant running in months and when it really flares up I can’t walk for days I seem to be going around in circles with no improvement at all. There seems to be a bit of swelling in the heel area and it throbs when I let it hang.Any advice would be muchly appreciated

  27. Miguel

    Thank you for your tip, doctor.
    I have been having heel pain since 2 years ago. It is not fascitis plantaris though.
    It has been growing gradually since then and nowadays it is too much to ignore it (it hurts when walking).
    The nerve flossing technique has helped me a lot in such a way that right after doing it I feel basically pain-free when walking. Although the pain eventually comes back later on, this technique helps me to get priceless free-pain moments throughout the day.

  28. James

    Hi, so glad to haver found this site and now really trying to figure where best to start and how to move forward.

    I have had extremely intense pain in my left heel for over 3 months, basically I can not bear to put weight on it when walking and exercise has not even been an option. I’m a sprinter and a coach and have had to stop all activity and basically hobble around my daily life at the moment. It was diagnosed as plantar fasciitis and I have rolled, stretched, iced and massaged by foot and calves more than I could ever imagine. I have now seen three physiotherapists and had my foot taped, stretched, scraped, worn nighsplints, tried acupuncture, used spikey little balls and mini foam rollers, and also had shockwave therapy. Sadly, I cannot say that my foot is any better today than it was in March. The pain just seems to move moved around – it has sometimes been worse in the arch but in recent weeks has been predominant in and around the

    I basically feel that the physios I have seen cannot see beyond a soft tissue injury – its PF (or maybe abductor hallucis!) surely this cannot be the case after 3 months? I have now reached my limit and have taken 2 weeks off work, to try and rest it and stop bearing weight – I’m using crutches and a protective airwalker boot to see if that helps.

    So, I’m trying to work out what to do? the article above and also this in the two links, have given me food for thought [broken links to https://www.regenexx.com/ removed]

    it a joint or nerve problem? or some sort of systematic inflammation problem?

    The foot problem is compounded by chronic pain in my neck, shoulders and an intense throbbing and tingling down my right arm. I had though these were separate issues but I’m now wondering if they are at all linked – possibly some sort of nerve pain affecting both my foot and arm? (although I’ve had MRI, CT, ultrasound and nerve conduction studies of my neck and shoulders and they haven’t thrown up any obvious answers.)

    Anyway, just desperate at this point … and hoping somebody with a similar experience can offer some hope. This is impacting every area of my life now from work, to social, exercise and being active with my children :(

  29. James

    Continued from above…. Meant to say “it has sometimes been worse in the arch but in recent weeks has been predominant in and around the inside edge and back of my heel”

    The rest, crutches, and protective boot is a recent tactic, only the past few days. Should I stop the foam rolling, stretches etc. to try and give my foot a break? Noticed previous advice which may hint that rest is the key to pain control.

    Any advice very much appreciated and must say thank you for the great article Joe.

  30. Pamela Pinnon

    I have a module under the skin in my arch. Hurts slightly when walking, but severely if I touch. Have had of in the past, this seems so very different. What could it be? Have not hurt my foot

  31. Loretta

    The nodule could be plantar fibroma.It’s caused when part of the fascia tears and forms into something like a scar tissue nodule.

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