Which statement best distinguishes plantar fasciitis from Achilles tendinopathy and outlines first-line management?

• A. Plantar fasciitis presents with medial heel pain worse in the morning and is treated with stretching, NSAIDs, and shoe/pad modifications.
• B. Plantar fasciitis presents with posterior heel pain and pain with resisted plantarflexion.
• C. Plantar fasciitis is best treated with immediate surgery.
• D. Achilles tendinopathy presents with medial heel pain in the morning.

Answer: (A)

Distinguishing plantar fasciitis from Achilles tendinopathy relies on where the pain is felt and how it behaves first thing in the morning, plus starting with non-surgical care. Plantar fasciitis typically causes pain on the medial aspect of the heel that is worst with the first steps after waking, due to strain and microtears at the plantar fascia’s origin. The best first-line approach targets reducing fascia tension and supporting the foot: regular stretching exercises (especially calf and plantar fascia stretches), NSAIDs as needed for pain, and shoe or pad modifications such as arch support or heel cushioning to lessen plantar fascia load during walking.

This pattern is distinct from Achilles tendinopathy, which usually presents with pain along the back of the heel near the Achilles tendon and is often provoked by resisted plantarflexion or heel-raise activities. Immediate surgery is not a first-line option for either condition; conservative, non-operative care is preferred initially.

Thus, the statement describing medial heel pain that’s worse in the morning and the plan of stretching, NSAIDs, and shoe/pad modifications best captures plantar fasciitis and its initial management.