Patients and doctors often confuse the terms heel spur and plantar fasciitis. While these two diagnoses are related, they are not the same. Plantar fasciitis refers to the inflammation of the plantar fascia–the tissue that forms the arch of the foot. A heel spur is a hook of bone that can form on the heel bone (calcaneus) and is associated with plantar fasciitis.
About 70 percent of patients with plantar fasciitis have a heel spur that can be seen on an X-ray. However, many patients without symptoms of pain can have a heel spur. The exact relationship between plantar fasciitis and heel spurs is not entirely understood.
Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an x-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.
Pain in the Heel
The plantar fascia is a thick connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia.
When a patient has plantar fasciitis, the plantar fascia becomes inflamed and weak (worn out)–these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight so even simple movements stretch the contracted plantar fascia. As you begin to loosen the plantar fascia, the pain usually subsides, but often returns with prolonged standing or walking.
Heel spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, x-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.
Treatment of Heel Spurs
Treatment of heel spurs is the same as treatment of plantar fasciitis. Because these problems are related, the treatment is the same. The first step in the treatment of a heel spur is short-term rest and inflammation control. Here are the steps patients should take in order to cure the symptoms of plantar fasciitis and heel spurs.
Avoiding the activity that caused the symptoms is the first step in treatment. For example, take a few day off jogging or prolonged standing/walking. Just resting usually helps to eliminate the most severe pain, and will allow the inflammation to begin to cool down.
Icing will help to diminish some of the symptoms and control the heel pain. Icing is especially helpful after a sudden flare up of symptoms.
Stretches & Exercises
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly
Anti-inflammatory medications help to both control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available. Anti-inflammatory medications can easily be used along with other treatment
Massaging the arch of the foot is often helpful to relieve symptoms of plantar fasciitis. Self-massage is often beneficial, and a professional massage therapist may also help significantly
Custom Made Orthotics
Orthotics are often a key to successful treatment of plantar fasciitis. The Orthotics often permit patients to continue their routine activities without pain. Shoe inserts that can be helpful include gel inserts, arch supports, and custom orthotics.
Night splints are worn to keep the heel stretched out when you sleep. By doing so, the arch of the foot does not become contracted at night, and is hopefully not as painful in the morning.
Extracorporeal Shock Wave Therapy
A new treatment for plantar fasciitis is called extracorporeal shock wave therapy, or ESWT. This treatment uses energy pulses to cause microtrauma to the tissue of the plantar fascia. This microtrauma is thought to induce a tissue repair process by the body. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options