A frequent misconception is that heel spurs—bony projections that form on the bottom of the heel bones (calcaneus)—are the most common cause of heel pain. In fact, heel spurs are considered a normal finding on an X-ray, and cause heel pain in only 5% of people who have heel spurs.1
Plantar fasciitis. The plantar fascia is a fibrous, soft tissue that stretches from the heel to the toes. If this tissue experiences small tears and inflammation it is called plantar fasciitis. Many people who have plantar fasciitis also have heel spurs that are visible on the X-rays.
Heel spur syndrome. Heel spurs, also referred to as calcaneal spurs, can develop on the bottom of the heel, where the plantar fascia inserts into the heel bone. People who have these spurs are sometimes diagnosed with heel spur syndrome.
In both heel spur syndrome and plantar fasciitis, the cause of pain is usually not the heel spur itself, but the injured plantar fascia. In most cases, the heel spur is simply an incidental finding on an X-ray, and heel pain symptoms are due to plantar fasciitis.
In fact, heel spur syndrome and plantar fasciitis have many similarities, including most risk factors and treatments:
Risk Factors. Both heel spurs and plantar fasciitis have several shared risk factors, including but not limited to repetitive athletic stress, obesity, tightness in the calf muscles, and high arches. In addition, osteoarthritis is also linked with heel spurs.2
Nonsurgical treatments. Nonsurgical treatment is initially recommended for both plantar fasciitis and heel spur syndrome, and these treatment recommendations are nearly identical. Initial recommendations include but are not limited to resting, changing footwear, and stretching the calf and plantar fascia.
If nonsurgical treatments do not work, a doctor may recommend a therapeutic injection, such as a cortisone or platelet rich plasma (PRP) injection, or another medical intervention. A person whose heel pain persists for at least 6 months may be a candidate for a surgical procedure called plantar fasciotomy.
Because the foot pain is typically caused by the injury and resultant inflammation of the plantar fascia and not the heel spur, the heel spur is typically not removed during plantar fasciotomy surgery.
Diagnosing Heel Pain
Diagnosing foot and heel pain involves a clinical evaluation, and possibly imaging.
Because plantar fasciitis is the most common type of heel pain, other causes of heel pain are sometimes misdiagnosed as plantar fasciitis.3 Imaging can aid in diagnostic confirmation of plantar fasciitis, while also helping to rule out other causes of heel pain such as a broken heel, heel spurs, or Achilles tendonitis.
A heel spur has typically been present for 6 to 12 months if it is detected on an X-ray.4 X-rays can also reveal stress fractures, calcaneal cysts, or other bone-related causes of heel pain.