If you’ve ever stepped out of bed in the morning and felt that sharp, stubborn heel pain, chances are you’ve thought, “This must be plantar fasciitis.” And sometimes, you’re right. Plantar fasciitis is one of the most common causes of pain on the bottom of the foot—especially near the heel.
But here’s the catch: a lot of heel and arch pain looks like plantar fasciitis, yet isn’t actually coming from the plantar fascia at all. And when the source of the pain is misidentified, people end up doing all the “right things”… with very little lasting change.
That’s why, in our office, we don’t just label heel pain and throw generic stretches at it. We treat foot pain like detective work—because the location of the pain isn’t always the cause of the pain.
What “True” Plantar Fasciitis Usually Feels Like
The plantar fascia is a thick, strong band of tissue on the bottom of your foot. It helps support your arch and absorbs stress during walking and running.
Classic plantar fasciitis pain usually shows up:
- Near the front edge of the heel bone
- Right where the fascia attaches
- Often worse with the first steps in the morning
- Can feel like a sharp “pinpoint” tenderness when pressed
That attachment point matters. Because if the pain sits more toward the back of the heel, spreads oddly into the arch, or doesn’t match the classic pattern, something else may be at play.
Heel Pain Can Be Caused by the Low Back (Even Without Back Pain)
One of the biggest plantar fasciitis “look-alikes” doesn’t even begin in the foot.
Sometimes, heel pain is actually driven by low back involvement, especially when nerves or surrounding tissues become irritated or restricted. Even if you don’t feel much back pain, your nervous system can refer symptoms down the chain—into the heel or arch—making it feel like a foot problem when it’s really a spine-and-nerve problem.
This is one reason some people try:
- inserts
- calf stretching
- foot rolling tools
- massage
- night splints
…and still don’t get improvements that
If the driver of the pain isn’t local, treating only the foot may help temporarily—but the symptoms often return and other times can get worse!.
Sometimes Fascia Isn’t the Problem… Your Foot Muscles Are
Even when the plantar fascia is irritated, it doesn’t always become inflamed randomly. Often, it’s being overloaded because the muscles that should support the arch aren’t doing their job well.
One clue we pay attention to is what your toes do when you’re relaxed. If your toes naturally curl, grip, or look “hammered,” it can mean the smaller foot muscles are overworking while the bigger stabilizers aren’t activating properly. That imbalance can shift too much load onto the plantar fascia.
So instead of endless towel scrunches and stretching, the goal becomes:
✅ improving foot muscle control
✅ restoring proper toe function
✅ reloading the fascia through the right systems
And as a bonus: better foot strength doesn’t just help pain—it supports balance and stability, which becomes even more important as we age.
Your Calf Might Be the Missing Link
Another commonly missed contributor? Calf strength and endurance.
If one calf is weaker—or even smaller—than the other, the foot often ends up absorbing forces the calf should handle. This is especially common after:
- ankle sprains
- fractures
- being in a walking boot
- recurring injuries
- or simply increasing activity (more steps, more miles, more work demands)
You might feel “fine” at first. But as demand stacks up, the weaker system falls behind—and the foot starts complaining.
The Takeaway: Assessment Changes Everything
Pain relief matters, but accurate assessment is the game-changer. Heel pain can come from the plantar fascia… or the back… or foot muscles… or calf weakness… or a combination of all three.
That’s why we take time to identify the true driver before creating a plan.
If you’ve been battling heel pain and nothing seems to work, don’t assume you’re broken—or that you just need more stretching. You may simply need the right diagnosis and the right strategy.
Because when we treat the cause—not just the symptom—your body finally has a chance to heal.