Plantar fasciitis and tarsal tunnel syndrome are both foot conditions in which there is pain at the sole of your foot and ankle. Both conditions usually present with similar signs and symptoms, which makes it hard to differentiate from each other. However, there are still some main differences between both conditions, which can be easily caught by a good podiatrist.

Plantar fasciitis

Plantar fasciitis is a disease or inflammation of the plantar fascia. Plantar fascia is a thick ligament present in the sole of the feet. It extends from the ankle to the toes of your feet.¹ Any condition which makes this thick ligament of your feet diseased or inflamed, will be called plantar fasciitis. 

Causes

Plantar fasciitis is caused by increased stress on the plantar fascia,² which can be due to a number of reasons. Tension or stress on plantar fascia can cause small tears. Repeated stretching and tearing of plantar fasciitis can make it inflamed or irritated, although the exact cause of plantar fasciitis usually remains unclear in many cases.

Risk factors

Plantar fascia can be inflamed or diseased due to a number of reasons, but some common factors include;

Foot type: Flat feet, high arches and an atypical walking pattern can put extra pressure on plantar fascia and can lead to plantar fasciitis.³

Occupation: Those, who have professions which require long time standing are prone to plantar fasciitis.⁴

Weight: Overweight and obesity can increase the chances of plantar fasciitis due to increased stress on feet.

Exercise: Certain types of exercise like long-distance running and aerobic dance or intense foot exercises without warm up can contribute to plantar fasciitis.

Shoes: Shoes with poor arch support and constant use of high-heeled shoes can lead to plantar fasciitis.

Sign and symptoms

Pain and stiffness in the feet is the main sign of plantar fasciitis, however, the pain of plantar fasciitis has some characteristic features like:

• Pain and stiffness is localized at the bottom of the heel
• Pain which is worse in the morning and can be relieved after some physical activity
• Pain which is accompanied after rest and sleep
• Pain which is accompanied with redness or tenderness in the heel area

However, it is not necessary that a plantar fasciitis patient should present with pain which has all these characteristics

Complications

Untreated plantar fasciitis can lead to a number of complications and can disrupt your daily activities. The longer it is left untreated, the worse its complications and the longer it will take to heal. The most common complication of plantar fasciitis is the tearing and rupturing of the plantar fascia. Due to compensating heel pain in plantar fasciitis, it could change your walking style which can lead to knee, hip and back problems.⁵

Treatment

First line of treatment for plantar fasciitis is conservative treatment. It includes rest, exercise and use of NSAIDS. Patients should avoid activities which strain their feet, like running etc. Exercises which includes stretching of plantar fascia are recommended for patients with plantar fascia. Patients of plantar fasciitis can take NSAIDS available over the counter for inflammation and heel pain. Correction of shoe type, and use of silicon pads is also necessary for plantar fasciitis. Complicated or chronic plantar fasciitis can be corrected by surgery, in which the ligament of the plantar fascia is cut to release the tension and swelling.⁶

Tarsal tunnel syndrome

Tarsal tunnel syndrome, like plantar fasciitis, is a foot condition which causes pain and numbness in the feet and soles. There is a passageway behind the ankle bones made by the ankle bones and ligaments, called tarsal tunnel.⁷ Its shape is like a tunnel and it is in the tarsal region, that’s why it is called tarsal tunnel. There are a number of important structures that pass through this tunnel, like vessels, nerves and ligaments etc. One of the important structures is the tibial nerveand compression of this tunnel will put pressure on the tibial nerve, thereby injuring or damaging it. This condition of pressing the tibial nerve in the tarsal tunnel is called tarsal tunnel syndrome.

Signs and symptoms

Pain in the feet and ankle region is the main symptom of tarsal tunnel syndrome. Along with pain, there will be tingling, numbness, and burning in the foot region. The differentiating symptom of tarsal tunnel syndrome is that the pain will be worsening with daily activities and reliving with rest and sleep. Other symptoms of tarsal tunnel syndrome include burning at sole, pain extending from the ankle to toes, weakness in the feet etc. However, it is not necessary to find all these symptoms in every patient.

Causes and risk factors  

Tibial nerve is the main nerve supply to the foot region. Anything which compresses this nerve in the ankle region will lead to painful feet, called tarsal tunnel syndrome. Flat feet or high arches, injuries to the ankle region and overuse injuries are some common causes of tarsal tunnel syndrome. However, there are some risk factors which increases the chances of this condition to occur, like 

Flat feet: flat feet or high arches are common risk factors for tarsal tunnel syndrome.

Injuries: ankle sprain or ankle injuries can lead to tarsal tunnel syndrome.

Medical conditions: Medical conditions like diabetes, arthritis and hypothyroidism can make you prone to tarsal tunnel syndrome. 

Others: other conditions like being overweight, having a long standing job and being an athlete increase your chances of having tarsal tunnel syndrome.

Complications

Complications of tarsal tunnel syndrome if left untreated includes, permanent nerve damage, weakness of feet muscles, difficulty in walking and standing, chronic painful foot, significant loss of touch sensation, in extreme cases it can lead to partial or complete loss of movement of toes.  

Treatment

Treatment of tarsal tunnel syndrome depends on the stage of the disease, in early stage it can be treated with just change in life style like avoid much use of ankle joint, by wearing orthotics or arch support to reduce pressure on foot, along with that your podiatrist can advices for some exercises which can help improve strength and flexibility of foot. In advance stage your doctor can give anti-inflammatory or painkillers or even steroid injections in your ankle. In a more advanced stage where there are chances of nerve damage and it is not responding with medication and physical therapy, then it will need surgical procedure to make another passageway for the tibial nerve behind your ankle to release pressure on it.  

Conclusion

Although both tarsal tunnel syndrome and plantar fasciitis cause pain in the foot, both have quite different in characteristics of pain. Plantar fasciitis involves ligament in the ankle while tarsal tunnel syndrome involves the nerve. Plantar fasciitis primarily causes stabbing heel pain due to inflammation of plantar fascia ligament, while tarsal tunnel syndrome involves tingling and numbness along with pain and discomfort in foot, due to pressing of tibial nerve ⁸. Plantar fasciitis pain usually worse in the morning or after rest and relives after physical activities, while pain of tarsal tunnel syndrome is opposite to it in which the pain is worse with physical activities and relives with rest. Location of pain of both conditions are also different, the pain of tarsal tunnel radiates from heel to toes while the pain of plantar fasciitis is mainly localized to heel region. Another main difference between both conditions is that pain of tarsal tunnel syndrome is along with loss of sensation of foot due to involvement of tibial nerve which is the main nerve supply of foot.  Highlight important differences, if possible, make bullet points