What are the key clinical features to differentiate between plantar fasciitis and Achilles tendinopathy in a patient presenting with heel pain?

Key clinical features differentiating plantar fasciitis from Achilles tendinopathy in heel pain:

• Plantar fasciitis typically presents with pain localized at the inferior aspect of the heel, especially at the medial calcaneal tubercle, which is worse on the first steps after rest or in the morning and improves with activity but may worsen after prolonged weight-bearing.
• The pain in plantar fasciitis is often described as sharp or stabbing and is aggravated by prolonged standing or walking, with tenderness on palpation of the plantar fascia insertion.
• Achilles tendinopathy presents with pain and tenderness localized to the posterior heel, specifically at or just proximal to the Achilles tendon insertion on the calcaneus.
• Pain in Achilles tendinopathy is typically aggravated by activities that load the Achilles tendon such as running, jumping, or uphill walking, and there may be swelling or thickening of the tendon.
• On examination, plantar fasciitis shows tenderness on the plantar surface of the heel, whereas Achilles tendinopathy shows tenderness and sometimes swelling over the Achilles tendon itself.
• Stretching exercises differ: plantar fasciitis management includes plantar fascia and gastrocnemius stretching, while Achilles tendinopathy focuses on eccentric loading of the Achilles tendon.

These clinical distinctions help guide diagnosis and management in primary care settings.

References: ¹