Plantar fasciitis and heel spurs are two different but closely related conditions that affect the feet and can cause heel pain. In this article, we will talk about these two conditions, including how they are related to each other and how to tell what is causing heel pain — heel spurs or plantar fasciitis. This will help you figure out which condition you may have and what you can do to get pain relief. 

What is plantar fasciitis?

A band of fibrous tissue connects the heel to the fatty pad at the front of the foot–It is called the plantar fascia, and it supports the arch of the foot, acting like a shock absorber. When the plantar fascia becomes irritated or inflamed, the condition is called plantar fasciitis. It is the most common cause of heel pain. Approximately 2 million Americans are diagnosed and treated for plantar fasciitis each year.

Cause

Stresses and strains on the feet are the most common reason for developing plantar fasciitis. Excessive pressure on the plantar fascia ligament damages the soft tissue. In response, there is inflammation, which results in a stabbing pain and stiffness at the bottom of the heel. 

Risk Factors

Plantar fasciitis can develop without any identifiable reason. However, certain things like tight calf muscles, high arches, obesity, repetitive activities like running, and new or increased physical activity are risk factors for plantar fasciitis.

Symptoms

Common symptoms of plantar fasciitis include:

• Pain under the heel.
• Pain in the foot after long periods of rest (on arising from bed, after a long car ride, etc.).
• Pain that tends to subside after a few minutes of walking.
• Pain that is worse after activity or exercise (not during).

What are heel spurs?

Heel spurs are a type of bone spurs (bony overgrowths) that develop in the heel in the area where the heel bone connects to the plantar fascia. Approximately 15% of Americans have heel spurs. 

Cause

Stresses on the foot ligaments lead to the formation of bone spurs in the heel. The body responds to the stress on the heel bone and soft tissue by building more bone and placing calcium deposits in the area. The bone growth in heel spurs develops slowly over time. Most people don’t realize they have a heel spur until they develop a sharp pain in the heel and seek medical evaluation.

Risk Factors

Heel spurs and plantar fasciitis share common risk factors, such as carrying extra weight due to obesity, wearing poorly fitted or worn-out shoes that don’t provide enough arch support, running or jogging on hard surfaces, and gait (walking) abnormalities that can affect balance and place stress on the heel bone and ligaments in the foot.

Heel Spur Symptoms

Only around 1 in 20 people who have heel spurs experience foot pain. Common symptoms of heel spurs include:

• A sharp pain, jabbing pain or burning pain in the heel when you first get out of bed in the morning.
• Pain continues during the day as a dull ache.
• Warmth in the affected area. 
• A small, visible bony protrusion under the heel.
• Difficulty walking barefoot due to tenderness at the bottom of the heel.

Are heel spurs and plantar fasciitis the same thing?

Plantar fasciitis and heel spurs are not the same, but they are closely related. Many people have both conditions together. However, one condition does not cause the other. Most people do not experience pain from a bone spur in the heel, but when they do, the heel pain can be very similar to plantar fasciitis pain. 

What’s causing my stabbing heel pain - a heel spur or plantar fasciitis?

The only way to know for sure is to seek a professional medical evaluation. Your doctor will listen to your symptoms and examine your feet. They may order tests such as X-rays to see what is causing your heel pain—plantar fasciitis or heel spurs—and check for other problems like fractures and arthritis. If these initial imaging methods do not reveal a cause, more detailed imaging with magnetic resonance imaging (MRI) or ultrasound may be required to diagnose plantar fasciitis or heel spur, but this is not usually needed. 

What’s the treatment for plantar fasciitis and heel spurs?

Nonsurgical Treatments for Plantar Fasciitis

• Rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation are the mainstay of plantar fasciitis treatment. 
• Your doctor might recommend exercises (stretches and/or physical therapy) to help relax tight calf muscles, which can aggravate plantar fasciitis. 
• Cortisone injections in the plantar fascia can help reduce pain and inflammation. However, there is a limit on the number of steroid injections you can get in the plantar fascia because they can cause the Achilles tendon to rupture, which can lead to flat feet and chronic pain.
• Supportive shoes with extra cushioning, plantar fascia inserts and custom orthotics can help reduce pain while standing and walking. 
• A night splint can help stretch the plantar fascia at night and reduce morning heel pain and the stabbing sensation you feel when you get out of bed in the morning. However, night splints can be difficult to wear and need some getting used to.
• Extracorporeal shockwave therapy (ESWT) is a non-invasive plantar fasciitis treatment that uses high-energy shock waves to stimulate healing in the damaged foot tissue. However, it has not shown consistent results.

Surgical Treatment for Plantar Fasciitis

If your plantar fasciitis symptoms do not improve after one year of nonsurgical treatments, your doctor may recommend surgery. This may consist of gastrocnemius recession (lengthening of the calf muscles) or plantar fascia release (where the plantar fascia is partially cut to relieve tension). A bone spur or heel spur can be removed at the same time. 

It is worth noting that the muscles, tendons, and ligaments in the lower body are all connected and work in tandem. Untreated plantar fasciitis can lead to ankle, knee, and hip pain over time because the stresses in the heel eventually create the need for these structures to work harder to compensate. That’s why it’s important to seek treatment for plantar fasciitis.

Nonsurgical Treatments for Heel Spurs

Once formed, heel spurs do not go away. Doctors treat heel spurs in the same way as they treat plantar fasciitis, with rest, avoiding activities that make the pain worse, ice, anti-inflammatory medications, and supportive shoes and shoe inserts. 

As mentioned above, heel spurs do not cause pain in many patients, and often the heel pain thought to be due to a heel spur is actually caused by plantar fasciitis. Treating both heel spurs and plantar fasciitis can provide pain relief.

Surgical Treatment for Heel Spurs

Doctors rarely perform surgery to remove a heel spur alone. However, heel spurs may be removed if you have plantar fasciitis surgery.

How to prevent plantar fasciitis and heel spurs?

• Run or jog on soft surfaces like tracks or grass rather than roads and sidewalks. 
• Avoid unsupportive footwear and high heels. Ensure your footwear fits well and provides arch support and fatty pad support (especially true for running shoes).
• Wear shoes (don’t walk barefoot) on tiles and hardwood floors.
• Get evaluated for a foot issue or foot condition that may potentially place pressure on your heels.
• Lose weight so there is less pressure on your feet.
• Don’t stand for long periods as this can place stress on your feet.

References:

1. https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs
2. https://my.clevelandclinic.org/health/diseases/21965-heel-spurs