Plantar Fasciitis Pain Location
No, plantar fasciitis does not typically cause pain only on the side of the heel—the classic presentation is pain on the medial (inner) aspect of the heel at the calcaneus, not lateral (side) heel pain. 1, 2
Classic Plantar Fasciitis Presentation
The characteristic pain location for plantar fasciitis is:
- Medial plantar calcaneal region (inner bottom aspect of the heel where the plantar fascia inserts) 3, 2
- Pain predominantly on the medial aspect of the calcaneus near the sole of the heel 2
- Tenderness with palpation of the medial plantar heel, not the lateral side 3
When Lateral Heel Pain Suggests Alternative Diagnoses
If your patient has lateral (side) heel pain, you should strongly consider these alternative diagnoses instead:
- Lateral ankle ligament injury (calcaneofibular ligament sprain), especially with history of inversion trauma 1
- Haglund's deformity with retrocalcaneal bursitis, which causes posterior and lateral heel pain from a prominent posterior superior calcaneus 1
- Calcaneal stress fracture, with tenderness localizing to the lateral calcaneal wall slightly posterior to the subtalar joint 1
- Lateral process fracture of the talus ("snowboarder's fracture"), particularly following inversion trauma 1
- Sinus tarsi syndrome 1
Key Examination Findings to Differentiate
To distinguish plantar fasciitis from lateral heel pathology:
- Point tenderness location is critical: Palpate the medial plantar heel insertion (plantar fasciitis) versus lateral malleolus, lateral calcaneal wall, or calcaneofibular ligament course (alternative diagnoses) 1
- Calcaneal compression test (squeezing heel medial to lateral): Pain suggests stress fracture, not plantar fasciitis 1
- Pain with passive ankle/first toe dorsiflexion: Suggests plantar fasciitis by stretching the fascia 3
- First-step morning pain or pain after prolonged sitting: Classic for plantar fasciitis 3
Common Pitfall
The most important pitfall is assuming all heel pain is plantar fasciitis. 1 Lateral heel pain should prompt consideration of traumatic injuries (ligament sprains, fractures), bony abnormalities (Haglund's deformity), or stress fractures rather than defaulting to a plantar fasciitis diagnosis. 1 If clinical examination reveals lateral rather than medial plantar tenderness, imaging with radiographs (if Ottawa Ankle Rules criteria met) or MRI/CT for persistent pain should be obtained. 1