Heel Spurs and Plantar Fasciitis…..is there a Difference?
You can easily see the heel spur, or as I like to call it, “Hell Spur” in the above X-ray. This patient began to experience pain in their heel region after a typical trail run. After a quick online search she diagnosed herself with Plantar Fasciitis. She diligently did all of the recommended internet home treatments. Rest, ice, Ibuprofen, stretching and rolling her foot out with a tennis ball. None of it seemed to work for her. In fact the pain seemed to be worsening. She had a Half Marathon looming in her near future and she could now barely walk without a limp. She decided to come to the San Diego Running Institute for help.
There are a couple of key differences between plantar fasciitis and heel spurs. During the exam I asked a few simple questions that allowed me to immediately know that she was not dealing with traditional plantar fasciitis. Below are the differences.
When a patient presents with heel and/or arch pain there are a couple of conditions we want to consider. Plantar fasciitis, plantar fasciosis, heel spur syndrome, Joggers Foot also called a calcaneal nerve entrapment and stress fracture of the heel. A simple orthopedic exam can quickly help eliminate a couple of these and zero in on the problem. In this case I used a flat diagnostic tool to “scrape” along the patients heel until I felt the bump that I knew was the heel spur. This finding coupled with her history allowed me to diagnose her with a heel spur and immediately begin to help direct effective treatment interventions. Treatment interventions for heel spurs vary slightly from treatment interventions for plantar fasciitis. I sent the patient for an X-ray to confirm the heel spur diagnosis (see the above X-ray) and began to educate her on how to properly care for this painful condition.
Plantar fasciitis is classified as inflammation of the plantar fascia where it originates on the heel. A heel spur is actual bone formation where the plantar fascia attaches at the heel. It is this bone formation that is painful. This is a critical point because it is not the actual spur that is painful. I have treated hundreds of patients with huge heel spurs that have no pain! You may be wondering how this can be. A typical example is a patient that comes to my office with a sprained ankle. When we get the X-ray back we notice that in addition to the sprained ankle they have a huge heel spur. I will casually ask the patient “Do you have any heel pain”? The normal response is “No”, I don’t…..but years ago I did”. What this tells us is that years ago while the spur was FORMING they had heel pain. Now that the spur is done forming there is no longer pain. So it our primary goal to STOP THE SPUR FROM CONTINUING TO FORM! Once you grasp the difference and understand why the spur is forming fixing heel spurs becomes much easier.
So how do I Stop the Spur from Forming?
My primary goals are dependent on the patient’s primary goal. If the patient has an event that they are training for and they want to get through that event than we use plan “A” to help ease the pain and stabilize the spur to minimize the formation of the heel spur. If the patient does not have a reason to train on their foot we immobilize their foot for a period of 2-6 weeks while we treat the heel spur and stop the heel spur formation in its tracks.
Plan “A” – A typical example is a runner training for a marathon, a hiker training for a trek through the mountains, a tennis player training for a big tournament or even someone whose job requires them to be on their feet and they can’t afford to rest at the current time.
Surgery and other Treatments for Heel Spurs
I frequently get asked about surgery for heel spurs. Remember, it is not the spur that is painful. Rather, it is the FORMATION of the spur. Surgery to remove a heel spur can often result in complications and more pain and disability!
Sometimes we do recommend a cortisone injection into the heel spur area but only if the person is resting and having the spur treated at that time. Cortisone is a powerful anti-inflammatory and can be used on occasion to help halt the spur formation. However, cortisone is also a powerful CATABOLIC hormone. A catabolic hormone is one that breaks things down….in this case your plantar fascia tendon is at risk due to its proximity to the heel spur. There have been quite a few studies that recommend against cortisone injections into this area because of the risk involved.
I also get asked about random treatments such as reflexology, acupuncture, lasers, prayer etc. While I do not deny that these treatments may be helpful for some I have not personally seen them be effective for the majority and do not recommend them for treating heel spurs.
If you have heel spurs and want help, an accurate diagnosis and effective treatment please let us help you. You can email me directly at Drrunco@sdri.net or you can call our treatment center at 858-268-8525.