Do I have plantar fasciitis or spurs? Diagnosing and treating heel pain

The most common cause of heel pain is plantar fasciitis, a condition that is frequently assessed and treated by physical therapists. Plantar fasciitis is often confused with another condition – heel spurs.

Determining condition

What’s the difference between plantar fasciitis and heel spurs, and will knowing whether you have one or the other change your course of treatment?

Feel the bottom of your foot. That tough tissue making up your arch is called your plantar fascia. It’s a taut band of fibers connecting the front of your foot to your heel that helps absorb forces as you move about.

If and when this tough tissue becomes irritated and injured, you’ll know it. Plantar fasciitis (“-itis” means inflammation) occurs when tiny tears in the plantar fascia develop, which can lead to a range of uncomfortable signs and symptoms, including:

• Pain near the heel or in the bottom of the foot (often described as “sharp,” “stabbing” or “achy”).

• Pain that gets worse after exercise or activity.

• Pain that’s worse first thing in the morning or after getting up after sitting for a long time.

Interestingly, there’s often no clear reason why plantar fasciitis develops. But we do know now that certain people are at greater risk. This includes sudden changes in your daily activity level or exercise routine. One example of this is if you participate in repetitive impact movements like running. If you have tight calf muscles – which can affect the movement and flexibility of the feet – flat feet or very high arches in your feet, it can also contribute to pain. Certain health conditions, including obesity, diabetes and pregnancy, are also more likely to cause the onset of plantar fasciitis.

Now here’s where heel spurs come in. A heel spur is a calcified bony overgrowth that develops on your heel bone, the calcaneus. If a heel spur is large enough, you may be able to feel it as a small protrusion beneath the skin near your heel. Like plantar fasciitis, it’s not always clear why heel spurs develop in some people and not in others. Ill-fitting shoes may be among the contributing factors.

It used to be thought that heel spurs cause plantar fasciitis, but this is no longer considered accurate. In fact, only approximately half of people with plantar fasciitis have heel spurs (you can see them on X-rays). Meanwhile, 10% of people are walking around with heel spurs (and many don’t even know it), and only 5% of people with heel spurs experience any heel pain

at all.

In other words, heel spurs may cause heel pain, but it’s not likely. It seems to be that heel spurs just happen to develop in some people, whether or not they go on to develop plantar fasciitis.

Treating heel pain

The fact that heel spurs often don’t cause pain means the chance of needing to have a bone spur surgically removed is low. Instead, other treatments for heel pain are likely to be effective.

If you have heel pain, it’s more likely to be caused by plantar fasciitis than by a heel spur. And if your symptoms don’t go away after a couple weeks of rest, talk to a physical therapist.

Physical therapy – which may include stretches, exercises, braces, lifestyle modifications and noninvasive pain-alleviating techniques – is recognized as an effective treatment for heel pain caused by plantar fasciitis and other conditions. And unlike medications, physical therapy also can help you tackle the underlying cause of your heel pain in addition to alleviating your symptoms, which can mean longer-lasting relief.

Consider working with a physical therapist the next time you’re kept off your feet by a painful heel.

Kim Gladfelter is owner, physical therapist and Pilates instructor at PhysioFit Physical Therapy & Wellness, 1000 Fremont Ave., Suite 108, Los Altos. For more information, call 887-6046 or visit physiofitpt.com.