Is it Plantar Fasciitis or Heel Spur Syndrome? Does it matter?

 

About Plantar Fasciitis

 

Plantar fasciitis quite literally means “underside of the foot tissue inflammation”, nothing more and nothing less. It is a medical term that defines a very specific foot condition, rather than the underlying reasons causing the condition. Without a stringent set of symptoms to define each of these conditions individually it’s very difficult to compare and contrast—and therefore separate—plantar fasciitis and heel spur syndrome.

Most articles lump the two conditions together under “heel pain” without delving further into the details of either issue, such as whether the pain was more acute in the morning upon waking or whether the afflicted area was sensitive to touch. Also, most articles very rarely specify whether or not a soft tissue growth was visible on x-ray and they rarely define the nature of the populations being studied.

Likewise, treatment analysis is very rarely broken down and the question remains as to whether a demographic like healthy male athletes experiences more success with suggested treatments than overweight, sedentary women, for example.  Without this type of detailed information it’s very difficult to compare the nature and outcome of heel pain to that of planter fasciitis, even more so because the research field on these conditions is so small.

About Heel Spurs

While plantar fasciitis refers to an inflammation found in specific connective tissue, heel spurs (medial calcaneal tubercles) are soft, malleable calcium deposits found on the heel of the foot. While spurs can be found on the back of the heel the specific type being referred to in this article refer to the growths found on the front, bottom and/or inside of the heel (medial subcalcaneal exostosis or tubercle of the os calcis). Contrary to popular conception the spur is not comprised of solid bone; it is simply a calcium deposit that has more in common with tissue such as cartilage.

The esteemed Merck Manual, which has been in existence for more than a hundred years, differentiates the two by calling it “heel spur syndrome” if inflammation of the plantar fascia causes heel pain and there is evidence of a heel spur and “the beginning stages of heel spur syndrome” if there is no evidence of an actual calcium deposit on the x-ray. When referring to pain that runs along the length of the plantar fascia only, the Merck Manual refers to it as “plantar fasciitis”.

Few doctors, however, bother defining heel pain with such specific designations; they simply use either term when referring to heel pain and use plantar fasciitis specifically when there is pain in the fascia but not in the heel.

What Causes Heel Spurs?

We hear a lot about the causes of plantar fasciitis but very little about the specific cause of heel spurs. One of the main reasons for this is the likelihood that heel spurs are the direct result of too much tension in the plantar fascia. This particular stretch of tendon supports the arch and is regularly under 200 pounds or more of tension, depending on a person’s body weight.

On occasion it may appear that heel spurs are created by excessive tension in the stretch of fascia that connects the big toe to the heel, especially if there is severe inward pronation of  the foot, but it’s more likely that the tension resides primarily in the inside part of that particular section of fascia. In this case it would be easy to conclude that the source of the pain begins with the big toe and travels down through the plantar fascia and into the heel but given how much tension is created in the arch of the foot this theory is quite unlikely.

Having an abnormal or uneven gait or an unorthodox shape and movement in the foot however, can create excessive tension in the entire extremity and this could, in turn, lead to the development of a heel spur. When we spoke of inward pronation earlier, it is the type of movement to which we refer to now. Flat feet and extreme supination can lead to the development of heel spurs as well.

Like plantar fasciitis, heel spurs are a very common foot condition; studies have shown that up to 21% of the population has heel spurs and that 30-70% of people that suffer from heel pain have spurs as well.

Does It Matter?

So at the end of the day the question is really this: Is it plantar fasciitis or heel spur syndrome, and does it matter? The short answer is no, not usually, because if it did matter than doctors would go out of their way to differentiate between to the two issues, and they do not.  If other afflictions have been eliminated and it’s one or the other then differentiation is not required as the same treatments are used for both of these conditions.

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