Patients and doctors often confuse the terms heel spur and plantar fasciitis. While these two diagnoses are related, they are not the same. Plantar fasciitis refers to the inflammation of the plantar
fascia--the tissue that forms the arch of the foot. A heel spur is a hook of bone that can form on the heel bone (calcaneus) and is associated with plantar fasciitis. About 70 percent of patients
with plantar fasciitis have a heel spur that can be seen on an X-ray. However, many patients without symptoms of pain can have a heel spur. The exact relationship between plantar fasciitis and heel
spurs is not entirely understood. Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis.
The main cause of heel spur is calcium deposit under the heel bone. Building of calcium deposits can take place over several months. Heel spurs happens because of stress on the foot ligaments and
muscles and continuous tearing of the membrane covering the heel bone. It also happens due to continuous stretching the plantar fascia. Heel spurs are mostly seen in case of athletes who has to do
lots of jumping and running. The risk factors that may lead to heel spurs include aormalities in walking which place too much stress on the heel bone, nerves in the heel and ligaments. Poorly fitted
shoes without the right arch support. Jogging and running on hard surfaces. Excess weight. Older age. Diabetes. Standing for a longer duration.
You'll typically first notice early heel spur pain under your heel in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up. When
you palpate the tender area you may feel a tender bony lump. As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel
release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.
Non Surgical Treatment
Ice compresses, stretching exercises, night splint for traction of the leg muscles to stretch the muscle in the back of the leg, and massage of the back of the leg, along with padding and heel
cushions are also things that you can do at home. The number one recommendation for relief of heel pain is wearing good shoe gear. Good shoe gear usually consists of a sturdy, solid shoe. Heel pain
is not relieved by a soft, ill supported shoe. Shoes such as Nike, K-Swiss, and Avia are the best shoes for this condition. Custom orthotics are highly recommended. Physical therapy is another way
physicians treat this condition. Ice packs, muscle stimulation, ultra sound, paraffin baths, and the new Plantar Fascitis Night Splint are also helpful. If all these conservative measures fail to
relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery is extremely beneficial for this condition, and for earlier
ambulation, the use of the newer Cast Walking Boot is recommended.
Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar
fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the
surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery
with typically smaller incisions on each side of your foot.