08/25/2026
Not all heel pain is plantar fasciitis.
In one review of 250 heel pain patients, plantar fasciitis accounted for 53%.
Which means nearly half of them had something else — and would not have gotten better on a fasciitis protocol.
The heel isn’t one spot. It’s five zones, and where it hurts narrows the list before you touch anything:
📍 Medial plantar, worst on the first steps → plantar fasciitis
📍 Central plantar, deep and bruise-like → heel fat pad syndrome
📍 Diffuse, hurts when you squeeze both sides → bone stress injury
📍 Burning, worse later in the day → Baxter’s nerve entrapment
📍 Back of the heel, not underneath → insertional Achilles tendinopathy
Swipe for all eight, how to tell them apart, and what the research actually supports for each.
A few things I’ve kept honest in here: the fat pad treatment evidence is genuinely thin — there are no solid randomised trials behind the heel cups and taping we all recommend.
The Sever’s evidence has real design problems. And the classic “load it” advice for Achilles insertional pain has a caveat: floor level only (initially), because dropping into dorsiflexion compresses the enthesis.
If your heel pain hasn’t budged in 6+ weeks of doing the right things for plantar fasciitis — it may not be plantar fasciitis.
This is not medical advice, please see a skilled practitioner to properly assess your heel pain.
