KEY TAKEAWAYS
- Plantar fasciitis, heel spurs, and Achilles tendonitis all cause heel pain but affect different structures, occur in different locations, and follow different pain patterns.
- An accurate diagnosis is the essential first step before any treatment begins. A podiatrist can distinguish between these conditions using physical examination, gait analysis, and imaging.
- Each condition responds best to treatments specific to its underlying cause. A Chandler podiatrist can discuss your options and what to expect.
Heel pain is one of the most common reasons adults visit a podiatrist and is also among the most misunderstood. Patients often arrive having already decided they have plantar fasciitis (because they read about it online and the morning pain fits) when they actually have insertional Achilles tendonitis. Others have been told they have heel spurs and assume that is the cause, when in fact the spur may be incidental, and the real problem is something else entirely.
Plantar fasciitis, heel spurs, and Achilles tendonitis can present similarly. Understanding the differences between these three conditions will help you describe your symptoms more accurately, ask better questions at your appointment, and understand why the recommended treatment plan looks the way it does. The Chandler podiatrists at Marvel Foot & Ankle Centers provide diagnostic evaluation and treatment for all types of heel pain. Here’s what you need to know.
Plantar Fasciitis: Pain at the Bottom of the Heel
The plantar fascia is a thick ligament-like band of tissue that runs along the bottom of your foot, connecting the heel bone to the base of the toes. Plantar fasciitis occurs when the plantar fascia becomes inflamed, usually from repetitive stress, biomechanical abnormalities such as flat feet or high arches, sudden increases in activity, or prolonged time on hard surfaces in unsupportive footwear.
Where It Hurts
The pain occurs at the bottom of the heel, typically near where the fascia attaches to the heel bone. It may radiate slightly into the arch.
When It Hurts
The defining characteristic of plantar fasciitis is first-step pain: the sharp, stabbing sensation with the very first steps in the morning, or after any prolonged period of sitting or rest. The fascia tightens during inactivity, and those initial steps stretch it abruptly. Pain often eases somewhat after a few minutes of walking as the tissue warms up, but may return after extended activity.
Diagnosis and Treatment
Diagnosis involves heel palpation, foot mechanics and gait assessment, and ultrasound or MRI when needed to confirm inflammation or rule out other conditions. Treatment ranges from stretching protocols and custom orthotics for mild to moderate cases to shockwave therapy, radial pulse wave therapy, and platelet-rich plasma for chronic or resistant plantar fasciitis.
Heel Spurs: A Finding, Not Always a Diagnosis
A heel spur is a bony growth, or calcium deposit, that develops on the underside of the heel bone. Spurs typically form in response to chronic stress on the plantar fascia or the Achilles tendon, where it attaches to the heel. They are very common, with studies suggesting that nearly half of people with plantar fasciitis also have a heel spur visible on X-ray. Critically, however, heel spurs are also found in people who have no heel pain at all. This is why podiatrists treat the spur as a finding to consider within context, not a standalone diagnosis.
Where and When It Hurts
When a heel spur is symptomatic, the pain tends to occur at the very bottom of the heel, in much the same location as plantar fasciitis. The pain pattern also overlaps: it can be sharp with first steps and more of a dull ache after prolonged activity. This similarity is part of why the two conditions are so often conflated and why imaging is important to understand what is actually contributing to the pain.
Diagnosis and Treatment
Heel spurs are visible on X-ray. If your podiatrist confirms that a spur is present and contributing to your symptoms, treatment focuses on reducing inflammation in the surrounding soft tissue rather than the spur itself. Spurs rarely require surgical removal. Conservative care—including offloading with custom orthotics, activity modification, and anti-inflammatory therapies—resolves the discomfort in most patients.
Achilles Tendonitis: Pain at the Back of the Heel
The Achilles tendon is the largest tendon in the body, connecting the calf muscles to the back of the heel bone. Achilles tendonitis is an inflammatory condition affecting the tendon itself, most commonly in one of two locations: the mid-portion of the tendon (a few centimeters above the heel) or at its insertion point directly on the heel bone. The insertional form is particularly relevant in the context of heel pain because its location overlaps with plantar fasciitis and can be confused with it.
Where and When It Hurts
Achilles tendonitis produces pain at the back of the heel, not the bottom. Insertional Achilles pain occurs at the bump where the tendon meets the bone. Non-insertional Achilles pain is located a few inches up the tendon and typically presents as stiffness and achiness in the calf-to-heel region. Pain tends to be worse in the morning and after periods of rest (similar to plantar fasciitis) but worsens with activity—particularly running, jumping, or climbing stairs—rather than easing as the foot warms up. Pressing on the back of the heel or squeezing the tendon reproduces the pain in Achilles tendonitis; pressing on the bottom of the heel near the arch reproduces it in plantar fasciitis.
Diagnosis and Treatment
Ultrasound and MRI help visualize tendon thickening, tears, or calcification within the tendon itself. Treatment for Achilles tendonitis typically involves a structured loading program (eccentric calf strengthening is well supported in the research), modification of aggravating activities, and footwear adjustments. Regenerative therapies can be effective for persistent cases. Our practice offers Remy laser therapy for Achilles tendon pain, platelet-rich plasma injections, and shockwave therapy as advanced options when conservative care is not sufficient. Achilles tendon rupture, though distinct from tendonitis, is a serious complication that highlights the need to evaluate persistent Achilles pain sooner rather than later.
A Quick Reference: Key Differences at a Glance
- Pain location. Plantar fasciitis and heel spurs cause pain at the bottom of the heel. Achilles tendonitis affects the back of the heel.
- Morning pain pattern. Strong in all three, but plantar fasciitis classically eases slightly with movement; Achilles tendonitis often worsens with continued activity.
- Aggravating activities. Plantar fasciitis worsens with prolonged standing on hard surfaces; Achilles tendonitis worsens with running, stairs, and explosive movements.
- Imaging findings. Heel spurs are visible on X-ray; Achilles and fascial pathology are best assessed with ultrasound or MRI.
- Treatment overlap: Custom orthotics and activity modification help all three; specific therapies differ.
Why Getting the Right Diagnosis Matters
Plantar fasciitis, heel spurs, and Achilles tendonitis are three conditions that overlap in location and symptom pattern but diverge in what makes them worse and what makes them better. A stretching protocol that relieves plantar fasciitis can aggravate insertional Achilles tendonitis. A treatment targeted at soft-tissue inflammation will not address bone-related spur pain the same way.
The Gilbert and Chandler podiatrists at Marvel Foot & Ankle Centers perform a thorough evaluation before recommending any treatment, because the right diagnosis makes the right treatment possible. If you are unsure what is causing your heel pain, an accurate assessment is the fastest path to relief.