Plantar Fasciitis or Something Else? How to Get the Right Diagnosis

🕒 Read Time: 6–7 minutes

(Because not all heel pain is created equal)

It starts as a little twinge when you get out of bed. Then it becomes a full-on hobble to the bathroom. Before you know it, every step feels like you're walking on a bruise made of nails.

If you're dealing with heel pain, there's a good chance you've heard the term plantar fasciitis. And yes—it’s incredibly common. But here’s the catch: not all heel pain is plantar fasciitis.

‍In fact, several other conditions can cause very similar symptoms. So if you've been stretching, icing, rolling your foot on a frozen water bottle for weeks—and you're still limping—it might be time to ask:
"Is it really plantar fasciitis? Or something else?"

‍Let’s break down what plantar fasciitis actually is, what else it might be, and how to get a proper diagnosis (hint: ultrasound can help).

What Is Plantar Fasciitis?

Your plantar fascia is a thick band of tissue that runs along the bottom of your foot, connecting your heel bone to your toes. It acts like a shock absorber and helps support the arch of your foot.

When this tissue becomes overloaded, irritated, or micro-torn, you get plantar fasciitis.

The classic signs:
• Sharp pain in the heel or arch
• Worse with the first steps in the morning or after sitting
• Eases with movement (but can return after standing or walking too long)
• Tenderness when pressing the inside of the heel

Sound familiar? You’re not alone—it’s one of the most common causes of heel pain, especially in runners, people who stand a lot, and those with flat feet or tight calves.

So What’s the Problem?

The problem is… lots of things can feel like plantar fasciitis.

And if you’re not treating the right cause of pain, your recovery will be slower—or not happen at all.

That’s why guessing (or googling) your way through it isn’t always the best approach.

What Else Could It Be?

Let’s take a look at some common “plantar fasciitis imposters.”

‍🔁 1. Plantar Fascia Tear
‍Sometimes, what feels like plantar fasciitis is actually a partial tear in the fascia—especially if the pain started suddenly, after a big step, sprint, or jump.

Key difference:
• Tears tend to hurt more during activity, not just first thing in the morning.
• They may cause bruising, swelling, or a distinct “pop” sensation when they happen.

🎯 Ultrasound can detect tears instantly—and help guide treatment.

🦴 2. Heel Fat Pad Syndrome
‍The fat pad under your heel acts like a cushion. But over time (or with repetitive pounding), it can wear down, shift, or become inflamed.

Key difference:
• Pain is directly under the heel, not on the inside or arch
• Feels like you're walking on a hard stone
• Often worse on hard surfaces or barefoot

🎯 Ultrasound can assess the thickness and quality of the fat pad.

💥 3. Calcaneal Stress Fracture
‍If you're very active, suddenly increased your training, or spend long hours on your feet, a stress fracture in the heel bone is possible.

Key difference:
• Deep, dull ache in the heel
• Pain gets worse with activity, not better
• May come with swelling or tenderness over the bone

🎯 Ultrasound can sometimes detect stress reactions, but an X-ray or MRI may be needed for full confirmation.

🧠 4. Tarsal Tunnel Syndrome
‍This is like carpal tunnel syndrome—but in your foot. A nerve gets compressed as it passes through the ankle, causing burning, tingling, or numbness.

Key difference:
• Pain may radiate into the arch, heel, or toes
• Often comes with pins and needles
• Can be worse at night

🎯 Ultrasound can visualise nerve swelling or compression and help rule this in or out.

⚙️ 5. Referred Pain from the Back or Calf
‍Sometimes, heel pain isn’t coming from the foot at all—it’s referred from the sciatic nerve, lower back, or tight calf muscles.

‍Key difference:
• May also have back pain, leg tightness, or weakness
• Doesn’t follow the typical plantar fasciitis pattern
• May change depending on posture or spinal movement

🎯 A good clinical assessment + imaging helps rule out referred pain.

How Can You Tell What’s Really Going On?

That’s where musculoskeletal ultrasound comes in.

Unlike an X-ray (which shows bone) or an MRI (which can take weeks to organise), ultrasound is perfect for soft tissue injuries—and it’s:
✅ Fast
✅ Affordable
✅ Radiation-free
✅ Often available in your physio or MSK clinic
✅ Immediate—results are available on the spot

What Can Ultrasound Show in Heel Pain?

• Inflammation or thickening of the plantar fasciaTears or microtears in the fascia
• Fluid or swelling around the heel
• Changes in the fat pad
• Signs of bursitis, nerve compression, or calcifications
• Healing progress over time

It’s dynamic, too—which means we can watch how your tissues behave during movement, loading, or pressure.

What Happens During the Scan?

It’s quick and easy:
1. You’ll lie on your front with your foot exposed
2. A small amount of gel is applied to your heel or arch
3. A handheld scanner glides over the area
4. The image appears on screen in real time—so you and your clinician can see what’s happening as you move or point to painful areas

‍Most scans take 10–15 minutes, and you’ll get results straight away—no waiting, no referrals, no guesswork.

What Happens Next?

Once you have the right diagnosis, your treatment can be tailored exactly to what’s going on.

• That might include:
• A targeted rehab program
• Footwear or orthotic advice
• Shockwave therapy for stubborn plantar fasciitis
• Ultrasound-guided injections if inflammation is severe
• Hands-on therapy or dry needling
• A referral if more complex imaging or treatment is needed

🎯 It all starts with knowing what’s wrong—so you’re not wasting time doing the wrong things.

Final Thoughts: Don’t Guess Your Way Through Heel Pain

Yes, plantar fasciitis is common—but it’s not the only reason your heel might be hurting.

If you've been self-treating without progress, or you're just not sure what you're dealing with, it’s time to stop guessing. A quick ultrasound scan could give you the clarity, confidence, and plan you’ve been missing.

Because limping through life? That’s not your style.

‍Heel pain that won’t quit?
Let’s scan it, diagnose it, and get you walking comfortably again.
Book your musculoskeletal ultrasound today.