Heel Pain vs Achilles Tendonitis: How to Tell the Difference
Heel pain and Achilles tendon pain are frequently confused — partly because they both affect the back and base of the foot, and partly because both tend to be worse in the morning or after rest. But they're different conditions, affecting different structures, and they respond to different treatments.
Treating the wrong one wastes time — and can occasionally make things worse. This guide explains the key differences, how to identify which one you're dealing with, and what effective treatment looks like for each.
The Structures Involved
Plantar Fasciitis (the most common cause of underside heel pain)
The plantar fascia is a thick band of connective tissue running along the sole from the heel bone to the toes. When this band becomes inflamed — typically from overloading or overuse — it causes pain at the heel where it attaches to the bone. This is plantar fasciitis.
Achilles Tendinopathy (Achilles tendon pain)
The Achilles tendon connects the calf muscles to the back of the heel bone. When it's overloaded, it develops micro-damage and inflammation — a condition called Achilles tendinopathy (or tendonitis in the older terminology). This causes pain along the back of the tendon and at the point where it attaches to the heel bone.
Where Does It Hurt?
Location is the single clearest way to distinguish between the two:
• Plantar fasciitis: Pain on the underside or front of the heel — at the inner edge of the heel base where the plantar fascia attaches. You can often find a specific tender spot by pressing firmly on the inner heel just in front of the heel bone.
• Achilles tendinopathy: Pain at the back of the heel and/or along the Achilles tendon, running upward from the heel toward the calf. There are two main presentations: insertional (right at the back of the heel bone, where the tendon attaches) and mid-portion (3–6cm above the heel, in the tendon itself).
If your pain is on the bottom of the heel, it's plantar fasciitis. If it's at the back — Achilles tendon. If you have both, it's possible to have both conditions simultaneously, which is more common than people realise.
When Is It Worst?
Both conditions share a characteristic morning pattern — but there are differences:
• Plantar fasciitis: Sharp, stabbing pain with the very first steps in the morning — often described as the worst it gets all day. Typically eases after 5–10 minutes of walking. Returns after prolonged sitting or rest.
• Achilles tendinopathy: Stiffness and aching at the back of the heel in the morning, which may also ease with movement. But Achilles pain is also characteristically worse during sustained activity (running, walking uphill) and often worsens progressively with repeated load rather than easing.
What Makes Each Worse?
• Plantar fasciitis worsens with: Standing for long periods, walking on hard floors barefoot, sudden increases in activity, wearing flat unsupportive shoes, being significantly overweight.
• Achilles tendinopathy worsens with: Running (particularly uphill or on soft surfaces), jumping, sudden increases in training load, tight calf muscles, wearing very flat shoes (which increase Achilles stretch).
Key Clinical Tests
For Plantar Fasciitis
Press firmly on the inner base of the heel — just in front of the heel bone, slightly toward the arch. Significant tenderness at this specific point is a strong indicator of plantar fasciitis. The pain is typically very localised.
For Achilles Tendinopathy
Run your finger up the back of the heel from the heel bone. For insertional tendinopathy, tenderness is right at the heel bone attachment. For mid-portion, there's a palpable tender area 3–6cm above the heel. The tendon itself may feel thickened or nodular. A characteristic test: pain that's reduced (not worsened) by gently rising onto the toes — which temporarily unloads the Achilles.
Treatment: The Differences That Matter
Plantar Fasciitis
• Plantar fascia stretching before first steps of the day
• Calf stretching — both gastrocnemius and soleus
• Arch-supportive insoles with heel cushioning
• Avoidance of flat, unsupportive footwear and barefoot walking on hard floors
• Activity modification during flare-ups
Achilles Tendinopathy
• Eccentric calf exercises — the most evidence-based treatment; involves slowly lowering the heel below a step
• Gradual return to loading rather than complete rest (which weakens the tendon further)
• A small heel raise reduces Achilles load in the short term
• Avoid stretching the Achilles aggressively in the early phase — this can worsen insertional tendinopathy in particular
• Ice after activity; anti-inflammatory measures
Note the contrast: plantar fasciitis benefits from stretching and arch support; insertional Achilles tendinopathy can be aggravated by aggressive stretching. Getting the diagnosis right matters.
Not sure which condition you have? Book an assessment at Finest Feet Footcare in Shifnal →
Frequently Asked Questions
Can I have plantar fasciitis and Achilles tendinopathy at the same time?
Yes — and it's more common than you might expect. Both conditions are driven by overload and tightness in the calf and Achilles-plantar fascia chain, so they often coexist. Treatment needs to address both, with appropriate care around the stretching recommendations for each.
How long does Achilles tendinopathy take to heal?
Mid-portion Achilles tendinopathy typically responds well to eccentric exercise programmes over 8–12 weeks. Insertional tendinopathy (at the heel bone) is often slower and more stubborn — it may take 3–6 months to resolve fully with consistent treatment. Patience is essential; pushing through pain sets recovery back significantly.
Should I see a GP or a foot care professional for Achilles pain?
A foot care professional can assess and advise on most presentations of Achilles tendinopathy. Your GP may be more appropriate if there's been a sudden, sharp pain that could indicate a tendon rupture, if the pain isn't responding to appropriate treatment after 3 months, or if you need imaging or specialist referral. When in doubt, starting with a professional assessment is a good first step.
Will my Achilles pain go away on its own?
Mild Achilles irritation from a one-off training spike may settle with rest and activity modification. Established tendinopathy — particularly if it's been present for more than 6–8 weeks — rarely resolves without active treatment. A structured eccentric exercise programme is the most reliable route to full recovery.
Book a Heel Pain Assessment in Shifnal
Whether you're dealing with plantar fasciitis, Achilles tendinopathy or aren't sure which one it is, our team at Finest Feet Footcare in Shifnal can assess your pain and point you toward the most effective treatment.
💚 Book your appointment at Finest Feet Footcare in Shifnal → — the right diagnosis leads to the right recovery.
Disclaimer: This article is general information and not a substitute for a clinical assessment. If you have diabetes and are concerned about your feet, please also consult your GP or diabetes care team.
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Email:finestfeetfootcare@gmail.com
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