When Foot Pain Isn’t Plantar Fasciitis: Conditions That Mimic Heel Pain

By Dr. Andrew Kakishita

Not All Heel Pain Comes From the Same Problem

Plantar fasciitis is one of the most common causes of heel pain, but it is not the only one. Many conditions can create pain in a similar area, which is why some people struggle to improve despite doing all the “right” things.

When heel pain does not respond as expected, it is often worth reconsidering the diagnosis.

Why Misidentifying Heel Pain Can Stall Progress

Different tissues require different approaches. Treating nerve-related pain like tissue overload, or vice versa, can delay recovery and increase frustration.

Understanding what is actually driving the pain helps guide more effective care.

Baxter’s Neuropathy

Baxter’s neuropathy involves irritation of a small nerve that runs along the inside of the heel.

This type of pain often feels different from plantar fasciitis. Common symptoms include burning, tingling, sharp discomfort, or pain that worsens with prolonged standing. Stretching the foot or calf does not always provide relief, and in some cases can make symptoms worse.

Because this is a nerve-related issue, treatment often focuses on reducing irritation, improving nerve mobility, and addressing contributing factors rather than aggressively stretching tissue.

Heel Pad Syndrome

Heel pad syndrome occurs when the natural cushioning under the heel becomes less effective.

People often describe this pain as deep, bruised, or sore directly under the heel bone. It is commonly worse when walking barefoot or on hard surfaces. Unlike plantar fasciitis, the pain is usually more centralized under the heel rather than along the arch.

Treatment focuses on load management, surface modification, and improving how forces are absorbed through the foot.

Key Differences That Matter

While plantar fasciitis, Baxter’s neuropathy, and heel pad syndrome can all cause heel pain, they behave differently.

The quality of pain, exact location, response to movement, and daily triggers all provide important clues. Imaging can help rule out certain issues, but it should not be the sole basis for diagnosis.

Choosing the Right Strategy Starts With the Right Diagnosis

If your heel pain has not improved despite consistent care, it does not necessarily mean the condition is severe.

It may simply mean the wrong tissue has been targeted. Identifying whether pain is tissue-based, nerve-based, or load-related changes the direction of care and often leads to better results.