Plantar Fasciitis and Heel Spurs
What is Plantar Fasciitis?
The ligament that supports the arch of your foot and connects the heel bone to the toes is called plantar fascia. Plantar Fasciitis is inflammation of this thick band of tissue. The primary symptom is a stabbing pain in the bottom of your foot, toward the heel. Alternatively, patients with this condition may experience tenderness throughout the underside of the foot, particularly towards the ball of the foot.
Plantar Fasciitis is sometimes called “first-step pain” because it is most painful in the morning, when you take your first steps of the day. It can also be triggered by a period of inactivity, or prolonged standing.
It is the most common cause of pain in the heel of the foot, affecting close to 2 million individuals who seek treatment for this condition each year.
What are Heel/Bone Spurs?
A heel spur is a small, abnormal bone growth that pokes out from the bottom of your heel, where the heel bone connects to the plantar fascia. About 15% of people are affected by heel spurs. Heel spurs are mistakenly thought to be the source of heel pain, but they are more typically a response to stress and strain along the plantar fascia and other foot muscles, tendons, and ligaments.
The body responds to the traction and pulling forces from these bands of connective tissue by building extra bone tissue. Over time, the extra bone tissue becomes a heel spur. Once they form, heel spurs are permanent and only removed with surgery.
How are Heel Spurs and Plantar Fasciitis Related?
While it is common for people with people with plantar fasciitis to also have heel spurs, they are not the same condition. They do, however, intersect. Plantar fasciitis causes inflammation along the ligament, and the stress and strain placed on the foot ligament leads the body to build extra bone tissue that becomes a heel spur.
The heel spurs do not cause pain in the heel, rather, they are another symptom of plantar fasciitis. This means the pain can be treated without removing the spur.
Causes
The plantar fascia plays an important role in normal foot mechanics during walking and is designed to absorb shock. However, tension and stress on the fascia can cause the ligament to lose elasticity, and even damage or tear the tissue. Since the body naturally responds to any injury with inflammation, this can cause heel pain and stiffness.
The cause of plantar fasciitis is not well understood, and it often develops without a clear etiology. However, certain factors can contribute to the condition.
Risk factors include:
- Repetitive impact activity. Exercises with repetitive movements—such as long-distance running, dancing, and sports—can put stress on your heel and plantar fascia. Additionally, a sudden increase in activity level can contribute to the onset of plantar fasciitis.
- Being overweight. Carrying additional weight puts extra stress on your plantar fascia.
- Age. This condition is most common in individuals between 40 and 60 years of age.
- Foot mechanics. Having a very high arch, flat feet, or tight calf muscles can affect the way weight is distributed when you walk. This can put added stress on the plantar fascia.
- Unsuitable shoes. Regularly wearing shoes that do not allow for natural movement or are unsuitable for the structure of the foot, such as high heels, flip-flops, or flat shoes, can increase pressure throughout the foot.
- Standing all day. Occupations that require you to be on your feet all day, such as teaching, can increase your chance of developing plantar fasciitis.
Treatment Options
90 percent of the time, patients with plantar fasciitis are able to recover over a period of several months using only simple treatment methods.
- Temporarily switching from exercises such as running or step aerobics, which can aggravate plantar fasciitis, to non-impact exercises such as swimming and biking can keep you active while you recover.
- Icing your foot several times a day for up to 20 minutes can reduce pain and inflammation.
- Nonsteroidal anti-inflammatory medication. Medications such as naproxen and ibuprofen can ease the pain of plantar fasciitis. If you need to take these drugs for longer than a month, be sure to discuss this with your primary care doctor.
- Physical therapy. Exercises to help stretch out the calf muscle and plantar fascia can relieve the pain that comes with this addition.
- Walking boot, cane, or crutches. Your doctor may recommend the use of a boot or crutches to help the fascia rest while you walk, allowing the tissue to heal.
- Night splints. A night splint stretches the plantar fascia overnight, relieving the patient of first-step pain in the morning.
- Custom-fitted arch supports can help distribute the pressure on your feet more evenly.
If conservative measures have not led to improvement after a year, your doctor may recommend cortisone injections or surgery to detach the plantar fascia from the heel bone.
If you have heel spurs in conjunction with plantar fasciitis, treating the plantar fasciitis will relieve some of the pain associated with the heel spur. Surgery to remove heel spurs are rare, although they may be removed during surgery to address plantar fasciitis.