Medically reviewed by Misty Seidenburg
Plantar fasciitis and tarsal tunnel syndrome both affect the foot and cause pain and discomfort, but they have different causes and treatments. Learn how to tell the difference and what you can do if you are dealing with nagging foot pain.
Plantar fasciitis, also known as plantar heel pain, is one of the most common causes of heel pain. It is inflammation of the plantar fascia, which is the thick fibrous band of tissue that connects the heel bone to the toes and runs along the bottom of each foot.
The most common symptom of plantar fasciitis is a sharp, stabbing pain in the bottom of the foot near the heel. For many people with this condition, the pain is the worst after sitting, standing, or sleeping for long periods. The first few steps of the day are often the most painful.
The plantar fascia absorbs the shock of movement when walking and supports the foot’s arch. Excess stress and tension on this connective tissue can cause microtears, and repeated tearing or stretching can also inflame or irritate it.
This can happen from repetitive activities like standing and running, significant weight gain in a short period of time, and even from wearing the wrong footwear for your foot type. Foot mechanics also play a role. A high arch or flat feet may affect how weight is distributed when standing, adding pressure on the plantar fascia. The condition is most common in individuals ages 40-60.
You can see a podiatrist or a physical therapist for plantar fasciitis treatment. Physical therapy can be a cornerstone in plantar fasciitis treatment, addressing all contributing factors and significantly improving the condition over time. Evidence is strong that physical therapy can help individuals with plantar fasciitis recover faster than others who do not seek treatment.
Consider scheduling a physical therapy evaluation as a first step, and follow up with a visit to a podiatrist if your symptoms do not improve with therapy. Recalcitrant cases may benefit from a specialist’s care.
Physical therapy treatment for plantar fasciitis has several components. Stretching and strengthening exercises target muscles in the foot and ankle, as well as the rest of the lower extremities, to relieve tightness and build strength in the muscles that support proper alignment.
Joint mobilization improves the range of motion in the foot and ankle joints, which can ease pressure on the plantar fascia. Dry needling is another modality that uses thin, sterile needles inserted into the skin to release tight trigger points underneath. Some patients find noticeable improvement after a single dry needling session.
Physical therapists can provide aids like night splints and custom foot orthotics and also educate patients on how to adapt daily activities to prevent symptoms. This knowledge equips patients to understand their condition and take proactive steps to prevent recurrence.
If you are among the one in ten people who know the pain of plantar fasciitis, you probably want to learn how to prevent it from happening again. The good news is that plantar fasciitis prevention strategies are highly effective for reducing fascia pain and inflammation.
Stretch it out. Be diligent about daily stretching, especially before and after activity. Calf stretches, toe curls, and plantar fascia stretches will improve flexibility and help prevent flare-ups.
Focus on low-impact exercise. If you are recovering from a plantar fasciitis flare-up, don’t return to high-impact exercise too quickly. High-impact exercises involving a lot of jumping and running can strain your feet excessively. Instead, opt for low-impact exercises like swimming or cycling. Work with your physical therapist to exercise safely and gradually increase intensity over time to allow your fascia to heal fully.
Avoid overuse. If you work on your feet, do a lot of standing, or participate in sports and activities involving jumping or running, it’s important to take breaks. Throughout your day, schedule rest periods to get off your feet. Switch up your workouts and training so that you are not repeating the same movements for prolonged periods.
Wear supportive shoes. Proper-fitting footwear is essential if you are prone to plantar fasciitis. This simple yet crucial step and custom orthotic inserts can provide the necessary arch support and foot alignment, guiding you toward prevention.
The tibial nerve runs through the tarsal tunnel, a passage of bones and ligaments on the inside of the ankle. Damage to the tibial nerve can cause pain, burning, and tingling in the ankle and the bottoms of the feet and toes. This condition is known as tarsal tunnel syndrome (TTS.) It can be confused with, or occur in conjunction with plantar fasciitis or posterior tibial tendinopathy.
TTS symptoms often occur on the inside of the ankle and the bottom of the feet. Along with pain, someone with TTS might experience numbness or a tingling “pins and needles” sensation. Weakness in the foot muscles is also possible. TTS symptoms often worsen during or after intense physical activity, and people with severe TTS may have pain and numbness all the time.
Tibial nerve damage has several possible causes. The anatomy of your foot can increase your risk of TTS, especially for people with flat feet or high arches. Some foot and ankle injuries, including sprains or fractures, can also affect the tibial nerve.
Individuals with chronic inflammation due to arthritis, diabetes, or other conditions may be at risk of developing TTS. Irregular growths or varicose veins that occupy space in the tarsal tunnel can also cause TTS.
Tarsal tunnel syndrome treatment and prognosis depend on the underlying cause. For people with masses or growths causing tibial nerve compression, symptoms generally improve once these are removed. People with chronic, systemic conditions should focus on managing symptoms with conservative treatments.
Physical therapy offers an integrated treatment approach for TTS. Strengthening and flexibility exercises and stretches are essential. TTS physical therapy may include manual therapies like soft tissue and neural mobilization, dry needling, and joint mobilization to relieve pain and inflammation. Proprioception and gait training help correct imbalances that affect foot position to reduce nerve compression.
Physical therapists also prescribe home exercise programs to manage symptoms and teach patients about lifestyle changes to improve their condition.
If you have TTS due to an injury or a physical mass, surgery and rehabilitation with physical therapy may be medically necessary. For others, management and prevention strategies are available to help keep your feet healthy and lower your risk of TTS pain.
Be diligent about exercise and stretching. Do your tarsal tunnel syndrome exercises consistently. Regularly stretching your calf muscles, ankle muscles, and plantar fascia helps to keep the ankle and foot structures flexible. Strengthening the foot and ankle muscles can reduce pressure on the tibial nerve and ease symptoms.
Wear proper footwear. Choose shoes that fit well and have good cushioning and arch support. Consider custom orthotics to maintain proper foot alignment if you have flat feet or high arches.
Warm up and cool down. Warming up the body with dynamic stretching before activity and cooling down with static stretching can help avoid tearing or damaging the tibial nerve and other structures.
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Foot pain may be a sign of plantar fasciitis or tarsal tunnel syndrome—or it could indicate something else entirely. It’s never a good idea to ignore unexplained ankle or foot pain because untreated symptoms can lead to more severe complications that impact mobility and quality of life. Early diagnosis and treatment are key to preventing the condition from worsening.
A physical therapy evaluation for foot pain is the first step in determining the cause and best course of treatment. With therapeutic movement and evidence-based manual therapies, relief may be possible without medication or surgery. Treatment plans are personalized to meet your needs and goals. Find a physical therapy clinic near you to get started!
