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Plantar Fasciitis vs. Achilles Tendinitis: Diagnostic Guidelines for Heel Pain and Effective Stretching Exercises

A Hispanic physician in his 40s examines the foot of a Hispanic patient in a modern medical consultation room. The patient is seated on an examination table with her leg extended, while the doctor palpates the heel area, focusing on diagnosing heel pain related to conditions like plantar fasciitis and Achilles tendinitis. In the background, anatomical posters of the foot and a digital tablet displaying an X-ray image of the foot highlight a contemporary clinical environment, emphasizing the importance of podiatry and stretching exercises in treatment.

Heel pain is a common complaint in clinical practice, with two of the most frequent causes being plantar fasciitis and Achilles tendinitis. Although both conditions may present similar symptoms, their diagnosis and treatment require distinct approaches. This article explores the key differences between these two pathologies and offers diagnostic guidelines for healthcare professionals.

Diving into Diagnosis

Plantar fasciitis is the most common cause of heel pain, characterized by pain in the medial aspect of the heel, especially upon taking the first steps in the morning or after prolonged periods of rest. This pain is due to inflammation of the plantar fascia, a band of tissue connecting the heel to the toes. The diagnosis primarily relies on the clinical history and physical examination, although in complex cases, ultrasound and shear wave elastography can be useful to confirm the diagnosis and assess the severity of inflammation.

On the other hand, Achilles tendinitis presents with pain at the posterior aspect of the heel, typically a few centimeters above the tendon insertion on the calcaneus. This condition is common among athletes and is associated with overuse of the Achilles tendon. Initial treatment is conservative, including eccentric stretching exercises and physical therapy. In cases where conservative treatment is ineffective, ultrasound-guided interventions may be considered.

Conclusions

The differential diagnosis between plantar fasciitis and Achilles tendinitis is crucial for the effective management of heel pain. A systematic approach that includes a detailed clinical evaluation and the use of imaging tools when necessary can significantly improve treatment outcomes. Additionally, implementing specific stretching exercises for each condition is fundamental for patient recovery.

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Created 6/1/2025