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Heel spurs

Even though the terms of heel spurs  and plantar fasciitis, are interconnected, they are not the same and can often lead to confusion in the minds of doctors and patients. Plantar fasciitis means the inflammation of tissues that forms the arch of foot called plantar fascia, whereas heel spurs mean the hook of bone that form on the heel bone or calcaneus. Heel spurs may accompany plantar fasciitis.

Around 70% of plantar fasciitis patients are found with heel spurs which can be identified by X-ray, but many patients of heel spur may not have the symptoms of pain. As yet the exact link between the two are not understood fully.

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Heel spurs are more common among plantar fasciitis patients who have a history of pain.

Heel spurs along with plantar fasciitis may happen to any age group, but are mostly seen in middle aged men and women.

The primary cause for painful plantar fascia is thought to be inflammation and irritation rather than heel spur. The heel spur is diagnosed by the help of X-ray, wherein a hook of bone is seen protruding from the foot bottom, where the plantar fascia is joined to the heel bone.

Causes and symptoms of heel spurs

Plantar fascia is thick tissue that connects the heel bone and the foot which assists in maintaining the arch of the foot with the help of its strong and tight tissues. It transmits the weight across the foot, when one walks or runs. That is the reason why a lot of pressure is put on the plantar fascia.

Patients of plantar fasciitis always have a worn out and inflamed plantar fascia causing the usual activities to become painful.

Pain symptoms are severe in morning after sleep. This is due to the fact that plantar fascia becomes tight after prolonged night rest. So, even simple movements cause the contracted plantar fascia to stretch.

The pain subsides when it is loosened, and activities that result in prolonged walking or standing may result in return of the pain.

For some, a prolonged plantar fasciitis can result in forming of heel spur.  About 70% of plantar fasciitis patients are found with heel spur, while the X-ray has shown that 50%  of heel spur patients had no symptoms of plantar fasciitis.

Heel spurs treatment

As the problems of heel spur and plantar fasciitis are similar, the treatment for both diseases stand the same. Short term rest and control of inflammation is the first step in treatment for heel spur.

The following are the steps that a patient needs to take for curing the symptoms of plantar fasciitis and heel spurs:

  • Rest: The first treatment method involves avoiding activities to prevent the aggravation of symptoms. Stopping of jogging or running for few days as well as avoiding activities that involve prolonged standing can result in much needed rest for a painful foot. A rest can also provide relief from inflammation and other symptomatic pain
  • Exercises and stretches: Doing designed exercises in mornings and evenings can help to relax the tissues and make the patients quickly feel better.
  • Application of ice packs: Icing can reduce the symptoms and pain, particularly after an acute exacerbation of symptoms.
  • Anti-inflammatory drugs : Anti Inflammatory medications which may either be prescribed by a doctor or obtained over the counter can help to control pain and inflammation.
  • Night Splints : Wearing night splints help to keep the heels stretched. This can help to prevent contraction of the foot arch and possibly reduce pain in morning when one gets up.
  • Shoe Inserts: For plantar fasciitis, shoe inserts are the most successful treatment, which allow patients to continue their routine without pain. The same is the case with heel spurs.

In most patients, the treatment methods mentioned above can definitely give relief from heel spurs and plantar fasciitis. Research indicates that most of them got relief within three months and 90% get relief within a year.

If the pain prolong, an injection of cortisone may be given to reduce the inflammation of plantar fasciitis. But doctors do not prefer this as it may create serious problems in heel area such as plantar fascial rupture in few cases and fat pad atrophy. It can also increase pain in rare cases of heel spurs.

For those patients who do not respond to the aforementioned treatment methods, a treatment called extracorporeal shock wave therapy (ESWT) can be used. It is under investigation and the method involves the use of energy pulses to induce microtrauma to the tissue around the heel spur. Such microtrauma is believed to induce tissue repair by the body.

Preventing the recurrence of heel spur after successful treatment

Proper fitting foot wear with shoe inserts if needed for relieving pressure over the tender area can prevent reoccurrence. If any problem appears with mechanical structure of foot, custom orthotics can be used. Continuance of stretching exercises can maintain the flexibility and prevent the reoccurrence.

What to do when the heel spur symptoms do not resolve?

Normally 5% cases may not get relief by the conventional treatment even after a year, after which one can consider the plantar fascia release surgery to loosen the plantar fascia.

Along with plantar fascia  release, most surgeons also advocate tarsal tunnel release, to prevent any diagnostic confusion. It has a success rate of about 80% in relieving pain.


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