Ever since running became a worldwide phenomenon, many have become familiar with plantar fasciitis. It’s a very common condition, and if you feel pain under your heel then there’s a big chance it’s plantar fasciitis. But about a third of pains similar to plantar fasciitis is not attributed to this condition at all.
Plantar fasciitis refers to a painful medical disorder caused by the inflammation of the plantar fascia, a ligament which runs along the soles of your feet. But you have to understand that your feet is made up of many bones, muscle and tissues so pain in this area doesn’t always mean you have plantar fasciitis.
Heel Pain in Children
For kids complaining of heel pain, it doesn’t make much sense to readily assume that it’s plantar fasciitis. The inflammation of the fascia may be more common among older people, but among the very young this problem is actually not so common at all. The following are possible causes of heel pain in children:
1. Sever’s disease. Also called calcaneal apophysitis, Sever’s disease is not really a disease but a medical condition characterized by the inflammation of the growth plate in the heel (called the physis).
This growth plate is sometimes weak, so when children run and jump around a lot the repetitive stress and the muscle strain can overburden it.
This is especially true if the child is obese, and that’s another similarity with plantar fasciitis. Also, it can affect one or both feet. This condition usually results in tenderness and pain at the bottom and at the back of the heel when the child is walking. The heel can be painful when the touched.
2. Tendo-Achilles bursitis. With this condition, the heel pain is caused by the inflammation of the bursa which is a fluid-filled sac you can find between the heel cord (the Achilles tendon) and the heel bone.
Like plantar fasciitis, this condition can be the result of wearing shoes that does not have sufficient cushioning. But it can also be caused by injuries to the heel while playing around. And even some disease (like juvenile rheumatoid arthritis) can also be the cause.
3. Fractures. It’s also entirely possible that a broken bone is the cause of the pain in a child’s heel. This can be an acute fracture but for children (especially when they’re younger than 10 years old) it is likely caused by jumping a few feet above the ground such as from a stair or a couch. It usually develops as a result of heavy impact.
Or it can be a stress fracture, which is caused by repeated pounding and impact to the bone. This stress can result in a hairline fracture which isn’t always easy to see in X-rays. This makes the condition more likely to worsen over time.
4. Achilles tendonitis. This is a condition caused by overuse of the feet. Just like plantar fasciitis,it’s also caused by repeated running and pounding over hard surfaces, which is why it’s rather prevalent among basketball, soccer, and track athletes. This condition usually affects children who are over 14 years old.
Soft Tissue Foot Problems
If you’re an adult and you’re experiencing pain in your foot, it may or may not be plantar fasciitis. First of all, the plantar fascia is a soft tissue in the foot, but it’s not the only soft tissue in that area in your body. Any of the other soft tissues can still get inflamed or injured after a long period of intense use. Now their symptoms may resemble that of plantar fasciitis, but that doesn’t mean that they require the same treatment.
Your real problem may actually be quite simple, and all you need is RICE treatment which stands for Rest, Ice (applying ice on the affected area to minimize the inflammation), Compression (applying a bandage to provide mild support), and Elevation (raising the injured area above the level of the heart as much as possible, which usually means you’ll need to lie down in bed and raise your foot high up with a stack of pillows).
But then some of these problems may actually need the very opposite of the treatment you usually get for plantar fasciitis. When your fascia is inflamed, your doctor may prescribe stretching exercises, which for some soft tissue problems may actually make things worse.
The list of potential problems that cause foot pain includes:
1. Torn foot ligament. This is the problem we mean when we say that stretching can be the last thing you need. This is also known more colloquially as a foot sprain. RICE is recommended, along with acetaminophen or an NSAID like ibuprofen. For severe sprains, the foot may be placed in a cast to avoid bearing weight
2. Ankle sprain. This is a very common problem among adults, and you shouldn’t have any trouble differentiating between your ankle and your heel!
3. Achilles tendonitis. This is the inflammation of the tendon connecting the lower leg calf muscles to the heel. Some people mistake it for plantar fasciitis because it also leads to heel pain during any activity involving running or even just standing.
4. Tendonitis. This is the inflammation of the foot tendons. It is also one of those conditions that can cause pain and swelling during stretching, or any other activity using the feet.
5. Compartment syndrome. In addition to severe pain, you’ll also experience some swelling and numbness (or tingling).
6. Morton’s neuroma. There are nerves and tissue between your 3rd and 4th toes, and when that thickens you’ll feel a sharp shooting pain in the ball of your foot. Your toe may also cramp and you’ll get this tingling sensation between the 3rd and 4th toes.
7. Infection. Your heel may hurt, but you may want to check it first for any open wounds. You may see a rash, swelling, or redness in the area.
Joint Problems Affecting the Foot
There are 26 bones and more than 30 joints in each of your foot. Any one of these joints can develop a problem, and this can be caused by several possible reasons. A joint is somewhat temperamental, because the problem may be because you used it too much, you didn’t use it properly, or that you didn’t use it enough. Regardless of the reason, the end result is always pain.
In general, joint pain is centered at the location of the affected joint itself. But sometimes the joints in your foot and ankle may radiate the pain to the joint’s surrounding areas. This may make it a little difficult to find out what’s causing the pain, and you could easily mistake it for a soft tissue problem instead.
The pain is usually treated with RICE, along with weight bearing limitations and a prescription for NSAIDs. If the symptoms do not improve, then you may need a foot and ankle surgeon to determine the exact cause of the joint pain and prescribe the appropriate treatment.
Foot Nerve Problems
It’s often easy to forget that nerve problems can cause pain in the foot or heel. They’re probably the least likely candidate for the cause of the pain. That said, it could still be a possible cause.
For example, repeatedly pounding the feet against a hard surface can damage the nerves of your foot. But it can also be caused by bad posture, and sometimes it is because of aging. All these can cause tension in the peripheral nerves, which run from your brain all the way down to your feet. Several factors that cause nerve-related heel pain also cause soft tissue problems and joint pain. That’s why you may have a combination of the three types of foot problems.
All these problems we’ve listed here can affect the foot as well as the heel. What this means for you is that you cannot simply assume that your heel pain is automatically plantar fasciitis. It’s true that an inflamed fascia is the most common cause of pain in this area but you can’t just assume this to be the case.
If it’s not plantar fasciitis but you treat it as such, you delay treating the actual problem and they can get much worse. And the treatment you give yourself may be the very thing that makes your condition worse.
So if you’re experiencing pain in your heel that you find it difficult to walk or stand properly, do yourself a favor and see a doctor. It’s true that you may have to bear some of the cost, but it’s worth it to be certain. Even if it is plantar fasciitis, your doctor can provide the best treatment for your particular case.
And if it’s not, then you save yourself a lot of pain and misery. You may be able to fix the problem quickly with rest, ice, compression and elevation, and you wouldn’t have to do the stretching and massaging that are often part of plantar fasciitis therapy.