When you have pain in your heel—when it feels like you’re walking on glass every time your foot hits the ground—you might not care whether it’s due to Plantar Fasciitis, or a heel spur, or a bruised heel. You just want the pain to stop.
But it’s helpful to know about the differences between Plantar Fasciitis versus Heel Spur Syndrome, if only for the reason that the two are closely related. Even many professionals use the terms interchangeably. It’s easy to become confused when terminology is not exact and there is little agreement about what constitutes which condition. You are researching your foot pain in an attempt to find relief—the last thing you need is a lot of mixed-up information that’s frustrating and confusing.
What is a Heel Spur?
A heel spur is simply a calcium deposit—not a hard, bony structure, but more like cartilage. On X-rays it will look “spikey” and painful, but in reality the shape is more like a shelf seen from the side. One reason medical professionals might attribute heel pain to a spur is because patients can see the spur in an X-ray, and it looks like something that would be stabbing the soft tissue of their heel. It’s easy to picture the pain, in other words.
But if a heel spur exists, it almost certainly is not the cause of your heel pain. Rather, it’s a symptom of the true cause, which is Plantar Fasciitis.
So What Is Plantar Fasciitis?
If you flex your foot and press with your fingers under the ball of your big toe, you will feel a large, firm ligament that stretches toward your heel. This is the inside edge of the Plantar Fascia. It is a broad band of fibrous tissue attached to the heel, which then fans out at the base of the toes. The whole assembly supports the arch of your foot.
When this tissue is strained (similar to a strained muscle), it can become inflamed and sore. Tiny tears in the ligament can also occur, particularly at the heel bone attachment point. This makes walking or standing painful, as the full weight of the body puts a load on the swollen, tender, ligament.This medical condition is called Plantar Fasciitis (PLAN-tar Fash-ee-EYE-tis). The name breaks down like this:
- Plantar means bottom of the foot
- Fascia is the type of connective tissue it is made of
- -itis is a suffix meaning inflammation
This inflammation of the Plantar Fascia can cause pain at the heel attachment point, or anywhere along the ligament up to the base of your big toe. The pain can be pinpoint sharp, or it can involve a major portion of the tissue. It can also move around throughout the day.
Where’s The Confusion?
When the Plantar Fascia pulls or yanks repeatedly on its attachment at the heel bone, the body responds by trying to grow more bone. Voilá! There’s your heel spur! Heel spurs exist in about 70% of Plantar Fasciitis cases. Some doctors look at the heel spur—when it exists in conjunction with the pain of Plantar Fasciitis—as an indication of how long the condition has been causing a problem. In other words, if you have Plantar Fasciitis and do not treat it, eventually you will develop a heel spur.
But many people have heel spurs with no accompanying pain. There’s no real explanation for why this is so. It could just be that the normal stimulation of the Plantar Fascia (not overextension, just extension) triggers the formation of extra bone in these people. Some professionals believe that heel spurs inevitably develop as we age—they are most common in people age 50 or more.
Whatever the reason, it’s clear that when you have foot pain along the Plantar Fascia—including at the site of a heel spur—it is due to irritation and inflammation of the Plantar Fascia itself. When a heel spur exists and the pain presents at the front of the heel, doctors are likely to attribute it to the heel spur. When a heel spur exists, but the pain is forward of the heel anywhere along the Plantar Fascia, it’s more likely to be called Plantar Fasciitis.
What’s The Treatment?
Whether or not pain along the inside bottom of your foot is diagnosed as Heels Spurs or Plantar Fasciitis, treatment is the same. Patients are advised to be active in both the research and selection of their treatments, because no one remedy works all the time for everybody.
A conservative-progressive approach is recommended. In most cases, pain can be reduced and healing facilitated without invasive procedures or complicated regimens. A typical therapy would be:
- Applying ice
- Resting the affected foot
- Stretching feet and calves before getting out of bed in the morning
- Modifying activities that might have led to the injury
One of the main causes of Plantar Fasciitis is a sudden increase in weight. If this applies to you, be sure to start losing weight once you’re mobile enough to exercise.
Further “self-treatment” can include takng ibuprofin and using pharmacy shoe inserts to provide more arch or heel support.
If the above remedies do not help, do not delay seeking medical help. The longer pain persists, the more chance that damage increases, necessitating more stringent measures. If treating the symptoms by yourself, at home, do not work, see your doctor and ask about night splints–to keep the ligament extended while you sleep—and physical therapy options.
If pain persists after these options are exhausted, or if your physican sees a need for more aggressive treatment, you may need to resort to:
- corticosteroid injections: deliver pain relief medicine directly into the injured Plantar Fascia. However, this treatment may weaken the ligament and lead to further damage.
- extracorporeal shock wave therapy (ESWT): sound waves are transmitted through damaged tissue in an attempt to stimulate them toward healing. This is a relatively new therapy.
- Surgery: direct manipulation of the ligament in an attempt to relieve the painful pressure. This would be the most extreme and expensive option, not only because of the surgery but because of the recovery period.