Plantar Fasciitis
Plantar fasciitis is the inflammation of the plantar fascia, a connective tissue in the sole of the foot that helps with walking and movement. It’s one of the most common causes of heel pain. The plantar fascia connects the heel to the toes, and with repetitive activities like walking, running, or overuse, it can lose its elasticity and become inflamed.
Heel Spurs
A heel spur is a bony growth that forms along the edges of a bone, specifically protruding from the bottom of the heel. These spurs develop gradually over time, and many people are unaware they have one until they experience heel pain and seek medical help. While bone spurs often occur alongside osteoarthritis, they may go undiagnosed for years unless symptoms of osteoarthritis, such as joint stiffness, prompt a visit to the doctor.
Heel Spurs vs. Plantar Fasciitis
- Plantar Fasciitis: This occurs when overuse stretches or tears the plantar fascia, the fan-shaped tissue on the sole of the foot. It typically causes intense, stabbing pain in the heel and sole that comes and goes throughout the day. The pain usually eases after walking but returns when you engage in activities that trigger it, such as sitting and then standing up again.
- Heel Spurs: These can develop as a response to the inflammation caused by plantar fasciitis. In reaction to the inflammation, the body may form new bone tissue, leading to the development of a heel spur. Heel spurs typically remain asymptomatic but can cause heel pain due to pressure or as a result of the ongoing plantar fasciitis.
Causes of Plantar Fasciitis
Anything that irritates or damages the plantar fascia can lead to plantar fasciitis, including:
- Standing for long periods
- Exercising on hard surfaces without proper warm-up or stretching
- Wearing unsupportive shoes (such as flip-flops or flat shoes) for extended periods
- Walking or standing barefoot for long durations
Certain health conditions can also contribute, such as obesity and flat feet.
Causes of Heel Spurs
Heel spurs are typically caused by:
- Arthritis
- Poorly fitted shoes
- Long-term muscle and ligament strain
- Walking or gait issues
Underlying medical conditions that can lead to heel spurs include:
- Plantar fasciitis
- Reactive arthritis
- Ankylosing spondylitis
Other Causes of Heel Pain:
- Nerve Entrapment: Causes a “pins and needles” sensation.
- Stress Fracture: Common in the heel and arch bones, with night pain, warmth, and sometimes swelling.
- Bursitis: Swelling around the foot caused by inflammation of the bursa (fluid-filled sacs that cushion the bones, tendons, and muscles in the joints).
- Fat-Pad Atrophy: Common in older runners, leading to reduced cushioning in the heel.
- S1 Nerve Radiculopathy: Pain referred from the lower back, often with back pain or stiffness.
A skilled health professional is needed to pinpoint the underlying cause.
Symptoms
- Plantar Fasciitis: The most common symptoms include pain in the heel and arch of the foot when standing after a night’s sleep, redness or warmth in the sole, and swelling around the heel.
- Heel Spurs: Most heel spurs are asymptomatic and may go undiagnosed unless discovered during routine X-rays. In some cases, they can cause heel pain that affects mobility.
Diagnosis of the Condition
Doctors begin by reviewing the patient’s medical history and performing a physical examination. They may also recommend imaging tests to determine the cause of heel pain, whether it’s from plantar fasciitis, a heel spur, or both.
The doctor may request one or more of the following diagnostic tools:
- X-rays
X-rays provide clear images of bones, helping to rule out other causes of heel pain, such as fractures or arthritis. Heel spurs can also be detected on X-rays.
- Other Imaging Tests
Additional imaging techniques, such as ultrasound or Magnetic Resonance Imaging (MRI), can be used to diagnose plantar fasciitis. An MRI may be recommended if the heel pain persists despite initial treatment.
Tips to Prevent Plantar Fasciitis:
If you’re an active person—whether you’re a runner or an avid walker—here are some tips to help lower the risk of developing plantar fasciitis:
- Avoid walking barefoot on hard surfaces.
- Wear socks with padded soles for extra cushioning and support.
- Avoid flat shoes; instead, choose shoes with slightly higher heels to support the plantar fascia.
- Stretch your lower body regularly with exercises like:
- Rolling a tennis ball under your foot’s arch.
- Stretch your toes backward.
- Massaging the arch and heel with a frozen water bottle.
- Rotate your shoes regularly. Get two pairs of shoes and replace them every 6 months.
- Rest from high performance activities at least once a week to prevent overuse.
Who Treats Plantar Fasciitis / Heel Spur?
An orthopedic surgeon will typically evaluate your condition first. Then, a multidisciplinary team—including a podiatrist (foot specialist), rheumatologist, orthopedic surgeon, and physiotherapist—will collaborate to create and deliver a comprehensive treatment plan.
Treatment Options
1. Non-surgical Treatment:
Most patients see improvement with non-surgical approaches. Key strategies include:
- Activity Modification: Reducing or changing activities that trigger pain (e.g., avoiding running on hard surfaces).
- Ice Therapy: Applying ice to the feet for 10 minutes every two hours can help relieve pain.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, or steroid injections (e.g., cortisone) into the plantar fascia.
- Stretching: Specific stretches may be advised for the foot and leg.
- Supportive Footwear: Wearing shoes with thick soles and extra padding and using orthotics or soft heel pads for additional support.
- Night Splints: These help stretch the plantar fascia overnight and can reduce morning heel pain.
- Physiotherapy: A physiotherapist can guide exercises to stretch the calf muscles and plantar fascia.
- Extracorporeal Shockwave Therapy: A non-invasive treatment that stimulates the healing process by sending high-energy shockwave impulses to the damaged fascia.
2. Surgical Treatment:
Surgery is considered only after 12 months of unsuccessful non-surgical treatment. Some options include:
- Gastrocnemius Recession: This surgery lengthens the calf muscles, relieving stress on the plantar fascia and helping patients with tight calf muscles.
- Plantar Fascia Release: A partial release of the fascia is done if ankle motion is normal, but heel pain persists. This procedure cuts the plantar fascia to relieve tension in the tissue.
What Happens if a Heel Spur Is Left Untreated?
Since heel spurs involve the formation of new bone in a critical area of your body—the heel, which is essential for walking and engaging in sports—leaving them untreated can lead to pain. The spur can put pressure on surrounding structures, like nerves, causing severe pain. Over time, this can result in significant disability and limited foot range of motion.
Conclusion
Plantar fasciitis and heel spurs are painful conditions that affect many people, but with the right treatment plan, most individuals can experience significant improvement. Whether it’s through activity modification, physical therapy, medication, or in rare cases, surgery, there are effective ways to manage the pain and prevent recurrence. At Reem Hospital, our goal is to provide you with personalized care that addresses your specific needs and helps you return to an active, pain-free lifestyle. If you’re experiencing heel pain, don’t hesitate to schedule an appointment with our specialists and take the first step toward recovery.
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