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.
Early signs of heel pain are usually due to plantar fasciitis, the inflammation of the plantar fascia. It is probably the most common cause of heel pain seen by the podiatrist. It is seen in all
groups of people; runners, athletes, weekend warriors, people who have jobs requiring a fair amount of standing, walking, or lifting, and those who have recently gained weight. The pain most often
manifests itself after periods of non-weight bearing when the plantar fascia is given a chance to rest, so your first steps cause a sudden strain to the tissue. Pain is most common with the first
steps in the morning and after periods of rest. Fortunately, upwards of 80 percent of those treated early do remarkably well with conservative therapy.
Although it may take years to become a problem, once it appears, it may cause considerable suffering. Because of proximity to the tendons, the spur is a source of continuous painful aching. The
sensation has been described as "a toothache in the foot." When you place your weight on the heel, the pain can be sufficient to immobilize you.
Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.
Non Surgical Treatment
The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rear foot
posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal. Other common treatments include stretching exercises, losing weight,
wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion
to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.
When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide relief of pain and restore mobility. The type of procedure used is
based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. Depending on the presence of excess bony build up, the procedure
may or may not include removal of heel spurs. Similar to other surgical interventions, there are various modifications and surgical enhancements regarding surgery of the heel.