Knee, Ankle and Foot Pain

Plantar Fasciitis or Achilles Tendonitis

Both plantar fasciitis and achilles tendonitis cause pain in similar areas, so many people get these two conditions mixed up. However, there are some very distinct differences between the two conditions. Understanding what makes plantar fasciitis and achilles tendonitis different will help you take better care of your feet.

One of the main differences between these two conditions is the underlying cause and location of all the pain and discomfort you are feeling. Both can be caused by either trauma or repetitive stress injuries, but the source of the pain is in entirely different spots.

Plantar Fasciitis

The plantar fascia is a bowstring shaped band of tissue that runs along the arch of the foot. As a ligament, its main job is simply to hold bones together in a stable position. The tough fibrous tissue can stand up to years of walking and running, but over time, tiny tears can develop in the ligament. Inflammation then builds up around these tissues, letting discomfort set in. Anything that puts a lot of pressure on the arch of the foot can lead to plantar fasciitis. People who have to stand a lot for work or those who are obese are more likely to develop the condition. Losing weight, wearing supportive shoes, and stretching before exercising can all help prevent plantar fasciitis.

Tendonitis

Tendonitis is caused by problems in the Achilles tendon that connects the heel to your calf muscles. This is a band of fiber that naturally has more motion and flexibility than a ligament. Therefore, basic pressure alone is typically not enough to cause damage, and it is less likely to tear. Instead, it becomes inflamed and damaged after a lot of intense overuse. People are more likely to get it from doing things like running for miles in unsupported shoes or playing sports that involve a lot of sudden stopping and starting.

Symptoms

These two conditions are commonly confused because of the similarities between their symptoms. Both can cause pain in the heel, and both tend to cause pain that gets worse when you put weight on your leg or foot. However, there are several distinct differences between symptoms, and considering the signs can help you figure out which condition is bothering you.

Signs of Plantar Fasciitis

Plantar fasciitis usually causes a stabbing pain along the bottom of your foot. It is mostly situated towards the heel but may spread towards the toes as well. Most people find that the pain is worse when they first wake up and take a few steps. Moving around throughout the day gradually tends to ease the pain. However, standing or sitting for long periods of time can reawaken it. Often, there is no pain while exercising, but you may notice the pain is worse the next day.

Tendonitis Symptoms

Pain in tendonitis is typically higher up than plantar fasciitis and it feels a little duller. It most often occurs as an ache at the back of the leg, though it can spread down to the heel or up to the calf. You will typically start out the day feeling fine, but it will gradually worsen as your day progresses. After any vigorous activity, a dull ache will start that eventually turns into throbbing pain. Things like running or climbing stairs tend to make tendonitis quite painful. Ultimately, tendonitis symptoms tend to get noticeably worse after exercise, while exercise can temporarily ease plantar fasciitis. In some cases, a soft lump that is tender to the touch may form around the ankle.

Treatment Options

The whole reason you need to figure out which condition you have is due to the fact that they have very different treatments. For both options, you can dull the pain by taking over the counter pain relievers and staying off the foot. However, if you want to actually treat the condition and return to former activity levels, you need more specialised care.

Plantar Fasciitis Treatments

For most cases, doctors recommend starting with various physical therapies. Treating plantar fasciitis mostly focuses on stretching the arch of the foot, so less pressure is placed on the plantar fascia. You may go to physical therapy, where you can learn exercises and stretches to help hold your foot in a healthier shape. Some patients do well with a custom fitted arch support to wear in their shoes and distribute pressure more evenly. Another option is a custom fitted splint that holds your foot in a stretched position at night. This can help take some of the tension off of your foot.

If more conservative care is not working, you may need more intensive treatments. Those who have chronic plantar fasciitis may benefit from extracorporeal shock wave therapy or ultrasonic tissue repair. This uses waves of energy to break up any damaged tissue and stimulate healing. In rare situations where plantar fasciitis does not respond to other treatments, surgery may be used. This detaches the fascia from the heel bone, so it is no longer under so much tension.

Treatments for Tendonitis

Tendonitis treatment options tend to focus more on strengthening instead of stretching. Exercises that help to strengthen the calf muscle help the leg move without putting undue stress on the tendon. One of the most common options is an exercise called eccentric strengthening. This involves slowly lowering the weight of your body after raising it. Instead of orthotics to support the arch of the foot, some people may do well with an orthotic that slips under their heel. This device holds the foot at a looser angle, so less tension is placed on your achilles tendon.

Compression wraps around the tendon can reduce swelling. Some patients also find that swelling goes down if they sleep with their foot raised at night. If basic lifestyle changes and physical therapy do not do enough to cure the problem, surgery may be needed. Repairing a damaged tendon can be quite challenging. In cases with minor tears, a surgeon may be able to suture the parts together. In more serious damage, you may need grafts from donor tendon material.