Heel pain is a frequent complaint, and the terms used to describe it are often confused. Many assume that a heel spur and plantar fasciitis are interchangeable, but they represent two distinct physical conditions in the foot. Understanding the differences between these common causes of heel discomfort is important for proper diagnosis and effective treatment.
What Plantar Fasciitis Is
Plantar fasciitis is a disorder involving the plantar fascia, a thick, web-like band of tissue running along the bottom of the foot. This fibrous tissue connects the heel bone (calcaneus) to the toes and supports the arch. The condition arises when the fascia becomes irritated, damaged, or undergoes degenerative changes near its attachment point on the heel bone. This is the most frequent cause of reported heel pain, accounting for up to 80% of cases.
The pain is typically sharp or stabbing and localized to the bottom of the heel. A hallmark symptom is pain that is worst with the first steps taken in the morning or after a long period of rest. As the individual moves and stretches the fascia, the pain often temporarily lessens, only to return after sitting or standing. The underlying problem is usually a chronic issue involving micro-tears and a breakdown of collagen within the tissue, rather than acute inflammation.
What a Heel Spur Is
A heel spur, medically known as a calcaneal spur, is a bony protrusion that forms on the underside of the heel bone. This formation is a calcium deposit that accumulates slowly over time, creating a small, hook-like growth. Heel spurs are a form of exostosis and can be easily visualized on an X-ray.
These bony growths vary in size and shape, sometimes growing up to half an inch in length. Heel spurs are a relatively common finding, affecting an estimated 15% of the population. Many people who have a heel spur do not experience pain from it, meaning the presence of the spur itself is not automatically a painful condition. The spur develops as a physical response to long-term strain and stress on the foot structures.
How These Conditions Interact
Plantar fasciitis and a heel spur are not the same condition, but they are often closely linked, which is why the terms are frequently confused. The spur is frequently a secondary development resulting from the chronic, long-term stress of plantar fasciitis. The persistent pulling and tension of the damaged plantar fascia where it attaches to the heel bone stimulates the body’s natural bone-forming process.
To reinforce the strained area, the body deposits calcium at the attachment site, which eventually hardens into the bony spur. This means the spur is typically a consequence of the soft tissue problem, rather than the primary cause of the initial heel pain. The pain is usually caused by the stress and micro-tearing in the plantar fascia tissue itself, regardless of whether a spur is present. Even when a heel spur is present, treating the underlying plantar fasciitis is what typically resolves the symptoms.
Common Causes and Risk Factors
Both plantar fasciitis and heel spurs arise from excessive or repetitive strain placed on the foot’s structure, sharing many of the same risk factors. High-impact activities, such as long-distance running or occupations requiring prolonged standing on hard surfaces, increase the stress on the plantar fascia. Carrying excess body weight also places greater pressure on the foot and heel, increasing the likelihood of tissue damage.
Biomechanical issues with the foot structure are also significant contributing factors. Individuals with either flat feet (overpronation) or unusually high arches experience altered weight distribution, which increases tension on the fascia. Age is another factor, as the plantar fascia becomes less flexible and the natural protective fat pad under the heel thins out over time. Tight calf muscles and Achilles tendons can limit ankle flexibility, causing increased stress on the heel and plantar fascia.
Treating Heel Pain Conditions
The management of both plantar fasciitis and a painful heel spur focuses primarily on conservative, non-surgical approaches. Initial treatment involves reducing the strain on the affected structures through rest and modification of activities, often substituting high-impact exercise with low-impact options like swimming. Applying cold therapy, such as icing the bottom of the foot, helps to reduce pain and local irritation.
Stretching exercises are fundamental, specifically targeting the calf muscles and the plantar fascia to improve flexibility. Supportive footwear with good arch support and cushioning is recommended. Over-the-counter anti-inflammatory medications can provide temporary relief from discomfort. Physical therapy or the use of custom or pre-made orthotics can help distribute pressure more evenly across the foot. Night splints, which hold the foot in a slightly flexed position while sleeping, are often used to keep the fascia lengthened overnight and prevent morning pain.