Being overweight or obese places significant stress on the area and thus may be an important causative factor. Inflammation of the subcalcaneal bursa may also cause plantar fasciitis, as may compression of the median calcaneal nerve or the nerve to the abductor digiti quinti. In addition, systemic inflammatory disorders, such as rheumatoid arthritis, Reiter's syndrome, and psoriasis, may produce plantar fasciitis. Before plantar fasciitis can be definitively diagnosed, several other conditions must be excluded. Unlike the pain of plantar fasciitis, which is located in the middle of the heel, subcalcaneal pain is present on the plantar surface of the heel.
Subcalcaneal pain is most likely related to bursa formation and inflammation.
Patients who have Haglund syndrome usually experience pain during stair climbing and other activities that involve heavy use of the Achilles tendon. Rarely do they have pain on arising in the morning, which is characteristic of plantar fasciitis. The swelling and crepitus caused by peritendinous edema can be significant. Patients with Achilles' tendinitis have pain during activity. Often, Tinel's sign is elicited by percussion of the nerve.