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 163 comments

  1. 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…

  2. 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.

  3. 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!!

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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 :(

  9. 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.

  10. 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

  11. 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.

  12. Sue


    I am not a runner however I have a horse and have been working him in hand up and down a short hill in his field short bursts of him in trot and me running in an effort to help him with early stiffness in his old age. Sadly I appear to have hurt myself (he is great) it is my right foot, it is not in my heel per se, it is on the sides inner and outer between the bottom of my heel and under my ankle bone. I can make it hurt by squeezing it from both sides so I am thinking it is more likely soft tissue damage caused by compression?

    I am treating it with ice packs and pain killers, it is easing slightly but has bugged me now for about a week, I have to do quite a bit of walking just looking after my horse, paddock maintenance etc and am limping at the moment.

    I wonder if anyone might have any suggestions other than pain killers and time?

    Thanks for your help in advance


  13. Deborah Spicer

    This is really interesting. I have a permanent L4/L5 nerve injury for past 15 years. Initially had significant sciatica for a number of years. I have reduced sensation on the outside of my right calf which goes to my big toe and adjoining toe, and some issues lifting my leg in a bent position behind me ( I need to grab my trouser leg to lift leg behind me). I do pronate significantly more so on the affected side which 4 years ago led to an effusion in the ankle joint. I have been wearing podiatrist prescribed orthotics ever since. Early this year my right arch started to hurt…no pain on waking, significant pain on sitting especially with my leg elevated, pain only with the first couple of steps…able to walk 5km, though experience some pain with steep accents and descents. I have noticed I have developed glute, hamstring and abductor pain and tightness in my right leg, and for the first time in years had a bout of sciatica in bed with bad pain in my calf and foot.
    Anyway I have been seeing a podiatrist and have a new set of orthotics….I have been doing the stretches as prescribed for what was diagnosed as plantar fasciitis…everywhere I read it talks about the hallmark sign of worse pain on waking. This sign I do not have….what I have is worse pain on sitting with or without elevation of that leg. I have expressed my opinion that I feel my foot pain is related to my back and my very tight and sore glutes, hamstring and inductor as I feel my foot pain is worse when these other areas cause me more grief. The strengthening exercises have done absolutely nothing. I have just tried the nerve flossing and my foot pain feels better not gone but improved. I’m having a remedial massage tomorrow and wil get him to also work on the fibrosis muscles along the sciatic pathway.

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