The term plantar fasciitis (PF)is generally used to define mechanical medial longitudinal arch or plantar heel pain in any location. Defining the exact location of complaint, and giving it a label, may change the treatment. The following is a more specific, but
incomplete, classification for those of I you with a particular interest in the foot:
Central heel pain syndrome: pain in the very center part of the plantar heel. Although related to a chronic stretching stress on the fascia, this version of heel pain is also irritated by direct contact with hard shoes floors and orthotics, much like a chronic contusion as as pronation brings weight-bearing towards the heel's center. Related to plantar fat pad atrophy from direct acute or chronic trauma and shear, these problems are
more often seen in heavier patients with genu valgum. This can later develop into lateral heel pain that occurs with chronic lateral weight bearing, used to avoid the more common medical heel pain.
Some type of cushioning or cutout for the center of the heel is often required to augment relief. When the central nature is recognized, one may better be able to predict when heel spur cushions will work or not work. In most cases the pathology is medial of center, and the central heel spur cutout is in the wrong place. Relief may also occur from the actual cushion elevating the heel somewhat, which in turn, reduces pronation and shortens the fascia.
Heel Pain Syndrome:
most common,a.m. pain, medial calcaneal pain and tenderness.
pain along the central body of the fascia, usually in the medial arch area, but always well distal to its calcaneal attachments.
nerve entrapments and irritations of the plantar nerve branches of the tibial nerve, often from direct pressure from the corner of the shoe or orthotic, as well as from biomechanical or other sources.
Tarsal tunnel syndrome, plantar fibromatous, Dupuytren's contracture, and other non-
mechanical causes of heel pain can include systemic diseases, neoplastic sources, other nerve entrapments at higher-levels, stress fractures, radiating pain from osteoarthritis or
osteomyelitis of the pain of subtalar joint, and referred vascular origin.
Figure 1. locates the most common sources of heel pain, with a specific label according to the area of laximal tenderness.