This article has been written to clear up the confusion that surrounds two of the possible causes of pain underneath the heel. Patients and practitioners alike seem to be using 2 different terminologies (Plantar Fasciitis or Heel Spur) to describe the same condition when in fact a Heel Spurs and Plantar Fasciitis are very different ailments.
So what causes heel pain, the Heel Spur or Plantar Fasciitis?
There is a common misconception that pain in the heel is caused by a Heel Spur when in fact it isusually caused by inflammation of the plantar fascia – Plantar Fasciitis. Heel Spurs can be present on the foot without there being any pain at all.
An example of a common heel pain situation follows:
A patient arrives at the Podiatry clinic and hands over an X-ray of the Left foot and an X-ray of the Right foot. The X-ray clearly shows a Heel Spur on both feet. The Heel Spurs look like small spikes coming away from the bone, shaped like small rose thorns. Further into the consultation the patient reveals that they have heel pain in only one foot, not both. It is fair to say then, that in this situation, that the Heel Spurs are not causing the heel pain, but that something else is. Typically, that something else is Plantar Fasciitis. Surely, if the Heel Spurs were the cause of heel pain in this patient then he or she would be experiencing pain in both heels.
Why the confusion?
It has been extremely common place for quite some time, that a large percentage of patients suffering with heel pain will visit their local GP before visiting anyone else. For many years, the common approach to these types of foot problems by a GP is a referral for X-ray. Understandably, these spikey bits of bone on the heel, that stand out like a sore thumb on the X-ray were, and sometimes are, still focused on by the GP and the patient. Heel Spurs look so out of place that it’s easy for the patient to accept that this spikey piece of Heel Spur is causing their pain. However, with the above information in mind it is safe to say that the Heel Spur isn’t the cause of pain, as they can be seen on X-rays of a pain free foot!
So what does cause pain?
Plantar Fasciitis causes pain. Of this there is no doubt. Plantar Fasciitis usually causes inflammation at the site of the Heel Spur, hence the confusion for patients and some practitioners. When we poke around at the site of the Hel Spur, we are prodding and pushing against an area of inflamed plantar fascia. When a patient reports pain from a Heel Spur they are really describing Plantar Fasciitis.
Why is it necessary to differentiate between a Heel Spur and Plantar Fasciitis.
An accurate diagnosis and a better understanding of the problem at hand will lead to the most appropriate treatment plan. The treatment plan that one would use for a Heel Spur would not necessarily help relieve Plantar Fasciitis, and vice versa. Most patients who misunderstand this concept will usually try to use soft shoes and soft pads inside their footwear in an attempt to cushion the Heel Spur. However, soft materials and cushioning create instability, and instability leads to further strain on the plantar fascia, which aggravates the condition. Therefore, correct treatment of Plantar Fasciitis should be to relieve strain on the plantar fascia with more supportive shoes and stronger materials as opposed to tying to cushion the heel with softer ones.
To conclude, it is important to understand that a Heel Spur does not cause pain, but rather the inflammation of the plantar fascia surrounding the Heel Spur. This really indicates that Plantar Fasciitis causes heel pain and not the Heel Spur itself. Therefore, we must treat the Plantar Fasciitis and focus less on the Heel Spur. Learn about the treatment here: Plantar Fasciitis Treatment
NB: This article refers to plantar heel spurs underneath the heel and not posterior heel spurs at the back.
Written by Karl Lockett