When you hop out of bed in the morning and feel pain at the bottom of your heel with your first few steps, you want to know what could be causing it. Even if it ends up going away later in the day, it's still bothersome. You might think it's plantar fasciitis based on your symptoms, but not so fast...could it be a heel spur?
Heel spurs and plantar fasciitis are two terms frequently used when discussing certain types of heel pain. And while they're actually very different issues, they can be addressed with the same types of treatment.
There are some misconceptions about how plantar fasciitis and heel spurs are connected. People tend to think that heel spurs are a common cause of heel pain, however that's not the case.
While heel spurs might be associated with pain, they are usually not the reason it occurs, as the Cleveland Clinic points out. Instead, the majority of the time when heel pain strikes, plantar fasciitis is the responsible party.
A heel spur, as explained by ScienceDirect, is a type of bone spur, or calcium deposit, that develops toward the back of the calcaneus, or heel bone, where the plantar fascia inserts. These small, jagged bumps of bone usually develop in response to lots of trauma—or damage—to the heel.
This means that in most cases, heel spurs actually form as a result of plantar fasciitis. If the plantar fascia continues to be damaged for a long period of time, the body will eventually create a heel spur to provide additional support for the heel.
Heel spurs are associated with a similar stabbing type of sensation in the heel that is usually worse in the morning and comes and goes throughout the day. But the major difference here is that the heel spur itself is rarely the actual cause of this pain.
In fact, about 10% of the population has heel spurs whether they know it or not, but only 5% of those with spurs will have heel pain. The true reason for pain in most of these individuals, as you might have guessed, is plantar fasciitis.
According to Podiatry Today, "plantar fasciitis is at epidemic levels with suggestions that one in six Americans may have the condition." As it has become so common, it's important to understand exactly what plantar fasciitis is.
The plantar fascia is a thick, connective band of soft tissue that stretches from the back of your heel to the base of your toes. As a ligament, it connects the bones in these two areas and it’s designed to be a shock absorber for the high amount of stress you put on your feet.
The plantar fascia is strong and can withstand a great deal of force, but too much pressure can damage or tear it. The body responds to this damage by becoming inflamed, and inflammation of the plantar fascia is called plantar fasciitis.
Plantar fasciitis is usually described as a stabbing pain under the arch and/or on the bottom of the foot near the heel. This pain tends to be worse in the morning and after long periods of standing, exercise, or rest. There may also be some redness and swelling in the area.
Sometimes plantar fasciitis can be confused with Achilles tendinitis. As the American Academy of Orthopedic Surgeons explains, "Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed.
The Achilles tendon is the largest and strongest tendon in the body. It attaches the calf muscles to the back of the heel and allows you to stand on your toes when walking, running, or jumping. When you train too hard or intensely without enough rest, Achilles tendinitis can occur, causing pain at the back of the heel or directly above it.
Here is one of the easiest ways to remember how heel spurs and plantar fasciitis are different. Many people have heel spurs without plantar fasciitis or heel pain, but it’s rare to find someone with plantar fasciitis who does not have a heel spur.
According to one study,approximately 50% of patients with plantar fasciitis also have bone spurs. Since about 1 in 10 people would show a heel spur on an X-ray of their foot, they are only considered an incidental—or insignificant—finding unless there is also foot pain.
When a heel spur forms, it is usually not responsible for causing any foot pain on its own. Instead, the pain is due to the foot condition that caused the spur. So, if you have a heel spur and notice pain at the back of the heel, you probably have Achilles tendinitis.
If the pain is on the bottom of the heel, plantar fasciitis is most likely the reason. Many people have heel spurs without any symptoms at all, and experts are still trying to figure out exactly how spurs relate to heel pain.
Since both plantar fasciitis and heel spurs result from a similar process, the risk factors associated with them are shared in common. The following factors increase the chances of developing both conditions:
It’s also important to point out that although the symptoms of plantar fasciitis and a heel spur seem similar, there is one way to help tell them apart. Plantar fasciitis symptoms may be felt in the arch as well as the heel, some patients have it for a while before they notice the stabbing heel pain. In rare cases where heel spurs are responsible, the jabbing pain will be centered in the heel.
If you’re experiencing heel pain, your doctor will examine your foot and may recommend an X-ray to confirm the diagnosis. Although plantar fasciitis is the most common cause of heel pain, it’s important to rule out other causes like Achilles tendinitis, stress fractures, a broken heel, or tarsal tunnel syndrome.
With a diagnosis of either plantar fasciitis or a heel spur, nonsurgical treatments are always recommended first and are usually successful. These include rest and ice, a change in footwear, heel cups, insoles, night splints, physical therapy and cortisone injections:
For people whose pain doesn’t improve after 6-12 months of trying these nonsurgical treatments, surgery is an option.
When it comes to heel spur vs plantar fasciitis conditions, it's important to remember that the latter often leads to the former. The good news is that more than 90% of patients with plantar fasciitis will improve in less than 10 months after following these simple nonsurgical treatments.
On the other hand, allowing the pain to persist or trying to push through it will only make matters worse and can lead to bigger foot problems.
With so many different options for treatment, it can be hard to figure out where to start. But, taking charge of your heel pain by finding one that works for you can have you experiencing more mobility and freedom as your heel pain gradually fades away.
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