The terms “heel spur” and “plantar fasciitis” can often be confused. The two diagnoses are unique from one another, but are related and are often seen together. It is helpful to understand the difference between the two, and to understand how they relate to each other.
Plantar fasciitis refers to a process that elicits pain in the bottom of the heel, along the bottom of the foot, and sometimes even into the toes. It is caused by excessive stress placed on the plantar aponeurosis, a thick piece of fibrous tissue that expands the length of the foot. The pain is most commonly seen at the origin of the plantar aponeurosis, or the plantar fascia, which is at the bottom of the calcaneus (heel bone).
The term plantar fasciitis is somewhat of a misnomer. The suffix “-itis” at the end of the word implies that there is inflammation in the plantar fascia. While this may be present in some cases, a majority of cases do not have any associated acute inflammation. Because of this, the term plantar fasciosis is probably a more appropriate term, which would refer to the condition as a chronic condition of pain. In scientific research, it is commonly referred to as plantar fasciosis.
A heel spur, on the other hand, is a piece of bone coming off of the bottom of the calcaneus. This is called an ostephyte. The cause of heel spurs is not completely understood, but it is generally accepted that they form from tractional pull on the calcaneus from the structures attached to the bone. This may include several muscles of the foot as well as the plantar aponeurosis.
Heel spurs are commonly associated with obesity, and can be seen in a number of different foot types. It has been reported that up to 92% of patients with heel spurs will develop ostephytes at other parts of their body. A heel spur on an x-ray can look like a very sinister problem, but it should be noted that the size of the heel spur does not correlate with the amount of pain associated with the problem. In fact, it is common to find that people will have heel spurs on both of their feet, yet only one side will be symptomatic.
Because both of the conditions are associated with each other, and the complaints of each are so similar, they may often be treated in the same manner. Generally a combination of rest, ice, stretching of the plantar fascia, and anti-inflammatory medications are sufficient in treating the conditions.
Strapping and taping are often employed by a physician to treat the problems, and orthotics may be prescribed as well. Functional orthotics may help to correct some of the biomechanical problems that lead to these two related conditions. By forcing the foot to function in a neutral position, much of the pull on the calcaneus can be eliminated. This can prevent the tensile pull on the calcaneus that can form heel spurs, as well as relieve the tension on the plantar fascia that may be causing the plantar fasciitis. Soft cushioning materials may also be used in the case of heel spurs to alleviate the pain.