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 usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.
The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.
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
Ice compresses, stretching exercises, night splint for traction of the leg muscles to stretch the muscle in the back of the leg, and massage of the back of the leg, along with padding and heel cushions are also things that you can do at home. The number one recommendation for relief of heel pain is wearing good shoe gear. Good shoe gear usually consists of a sturdy, solid shoe. Heel pain is not relieved by a soft, ill supported shoe. Shoes such as Nike, K-Swiss, and Avia are the best shoes for this condition. Custom orthotics are highly recommended. Physical therapy is another way physicians treat this condition. Ice packs, muscle stimulation, ultra sound, paraffin baths, and the new Plantar Fascitis Night Splint are also helpful. If all these conservative measures fail to relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery is extremely beneficial for this condition, and for earlier ambulation, the use of the newer Cast Walking Boot is recommended.
Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.