Heel Spurs: Causes, Treatment, and Surgery

Patients and doctors often confuse the words 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 often associated with plantar fasciitis.

About 70% of patients with plantar fasciitis have a heel spur that can be seen on an x-ray. However, many patients without symptoms of foot pain can have a heel spur. The exact relationship between plantar fasciitis and heel spurs is not entirely known.

The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia are thought to be the primary problem. A heel spur diagnosis is made when an x-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

The plantar fascia is a thick connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run.

When a patient has plantar fasciitis, the plantar fascia becomes inflamed and small tears can occur; these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight and simple movements stretch the tightened plantar fascia. As you begin moving around, the fascia loosens and the pain usually subsides.  However, symptoms often return after a day of prolonged standing or walking.

Heel spurs form in some patients who have plantar fasciitis and tend to occur in patients who have had the problem for a prolonged period of time. While about 70% of patients with plantar fasciitis have a heel spur, x-rays also show about 50% of patients with no symptoms of plantar fasciitis also have a heel spur.

Treatment of heel spurs is the same as treatment of plantar fasciitis. Because these problems are related, the treatment is the same. The first step in the treatment of a heel spur is short-term rest and inflammation control. Here are the steps patients should take in order to cure the symptoms of plantar fasciitis and heel spurs.

Many patients found to have a heel spur worry that they may need to have the bone removed.  Fortunately, even when surgery for heel pain is necessary, removal of the spur of bone is not typically performed.  That's why doctors aren't too concerned when they see the heel spur on an x-ray--it doesn't really change the way the condition is managed.