Heel pain is a frequent complaint that often sends people searching for answers about two confusingly similar conditions: plantar fasciitis and heel spurs. These two diagnoses involve the same region of the foot and frequently occur together, leading to misunderstanding. Understanding the differences and the connection between these two entities is necessary for correctly identifying the source of discomfort and guiding effective treatment.
Defining Plantar Fasciitis and Heel Spurs
Plantar fasciitis is a condition involving the thick band of tissue running along the bottom of the foot, known as the plantar fascia. This fibrous ligament connects the heel bone to the toes and helps support the foot’s arch. The condition arises from repetitive stress or excessive pressure that causes micro-tearing in the fascia, typically near its attachment point on the heel bone, which triggers pain and stiffness.
A heel spur, by contrast, is an anatomical change in the bone itself. It is a calcium deposit, or bony protrusion, that slowly forms on the underside of the heel bone, which is called the calcaneus. Heel spurs are not the same type of inflammatory tissue problem as plantar fasciitis, but rather a structural growth. This bony projection is often discovered incidentally on X-rays taken for other reasons, as many individuals with heel spurs experience no pain at all.
The Causal Relationship
These two conditions are intimately related because chronic plantar fasciitis often acts as the precursor to a heel spur. When the plantar fascia is subjected to long-term strain, it pulls repeatedly on the periosteum—the membrane covering the heel bone—at its insertion point. The body’s response to this constant tension and micro-trauma is to deposit calcium in an effort to strengthen the area, which is why it is frequently a secondary result of a prolonged plantar fasciitis issue.
It is possible to have plantar fasciitis without a heel spur, and about half of patients with plantar fasciitis will also have a spur visible on an X-ray. The spur itself is typically not the source of the discomfort; the pain is caused by the surrounding inflammation from the underlying plantar fasciitis.
Identifying Differences in Pain and Location
The specific pattern and location of the pain is the most distinct difference between the two conditions. Plantar fasciitis classically presents with a sharp, stabbing sensation when taking the first steps in the morning or after a long period of rest. This “first steps” pain typically subsides slightly after walking for a few minutes but may worsen again later in the day with prolonged activity.
The pain from plantar fasciitis is usually felt on the bottom of the heel, slightly forward where the fascia attaches to the bone, and can sometimes extend along the arch of the foot. If a heel spur is symptomatic, the pain tends to be more intensely localized directly under the heel bone, where the bony growth is situated.
While both can cause pain upon weight-bearing, a truly symptomatic spur may feel like a sharp, stabbing sensation when direct pressure is applied to that specific point. Medical professionals use the characteristic location of tenderness—just in front of the heel bone on the sole—as a strong indicator for diagnosing plantar fasciitis.
Managing Both Conditions
The treatment for both plantar fasciitis and a painful heel spur is nearly identical because the primary goal is to resolve the underlying inflammation and tension in the plantar fascia. Conservative care is the first-line approach and is successful for approximately 90% of patients.
Common treatments involve regular stretching exercises for the plantar fascia and the Achilles tendon to improve flexibility. Supportive measures include wearing appropriate footwear with thick soles and good arch support, as well as using custom or over-the-counter orthotic devices. Other therapies include applying ice to reduce inflammation and utilizing nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
In chronic cases, a night splint can be used to hold the foot in a slightly dorsiflexed position, which gently stretches the fascia overnight. Surgical removal of the heel spur is rarely recommended, as it does not address the cause of the pain and is typically reserved for cases that have failed conservative treatment.