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.
A heel spur is caused by chronic plantar fasciitis. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis. When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.
Heel spurs can be quite painful, but can just as likely occur with no symptoms at all. Plantar fasciitis is a contributing condition to heel spurs. The cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. The feeling has been described as a knife or pin sticking into the bottom of your feet when you first stand up after sitting or laying down for a long period of time - a pain that later turns into a dull ache.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.
Non Surgical Treatment
Heel spurs and plantar fascitis are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding re-injuring the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the proper fitting of shoes are all important measures to decrease this common source of foot pain. Modification of footwear includes shoes with a raised heel and better arch support. Shoe orthotics recommended by a healthcare professional are often very helpful in conjunction with exercises to increase strength of the foot muscles and arch. The orthotic prevents excess pronation and lengthening of the plantar fascia and continued tearing of this structure. To aid in this reduction of inflammation, applying ice for 10-15 minutes after activities and use of anti-inflammatory medication can be helpful. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound that creates a deep heat and reduces inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with an ace bandage will help. Corticosteroid injections are also frequently used to reduce pain and inflammation. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.
In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.
Prevention of heel spur syndrome may be best by finding a good supportive shoe. Never go barefoot or wear a flat soled shoe. There are many over the counter arch supports that give increased support for your feet. Usually when there is excessive pronation the Achilles Tendon contracts or becomes shortened over time since it is not being used fully. The shortened Achilles Tendon is called an equinus deformity. By keeping this tendon stretched it may decrease some of the tension in the foot. Some theories believe the Achilles Tendon and plantar fascia is continuous. Before you get up from rest, stretch out your Achilles and the plantar fascia. You may attempt to spell the alphabet with your foot and ankle, use a towel against pressure on your foot, or roll a can of soup or sodapop on the ground. Ice may work well at the times of severe pain. For a chronic pain, or longer lasting pain heat therapy may improve the condition.