Heel Pain or Plantar Fasciitis
When you break down the etymology of plantar fasciitis it literally means “underside of the foot, tissue inflammation”, and this is the literal medical definition of the condition as well. The wordsplantar fasciitis indicate a precise condition of the plantar fascia and nothing more. Plantar fasciitis simply indicates that the plantar fascia, found on the bottom of the foot, has become inflamed, and this alone tells us that it is not the same thing as heel spurs.
Having said that, most doctors are not very worried about keeping these conditions separate; they are most often lumped together under the topic of ‘heel spur syndrome.
Most studies of both injury and treatment are also specify whether the subjects interviewed, studied, or treated were physically active men or older, overweight women, for example. They also do not specify which conditions (plantar fasciitis or heel spurs) are likely responsible for specific symptoms. Without these types of details it becomes even more difficult to discover what kind of differences there truly are between plantar fasciitis and heel spur syndrome.
An Overview of Heel Spurs
Plantar fasciitis indicates an inflammation in the connective tissue of the foot whereas heel spurs (medial subcalcaneal exostosis or tubercle of the os calcis) refer to soft, malleable deposits of calcium that can be found on front, bottom, and/or inside of the heel. These deposits can also be found on the back of the heel but they are slightly different in nature and therefore not referred to in this article. Calcium deposits are closer in nature to cartilage than bone.
The longstanding medical reference, the Merck Manual, differentiates between these conditions by referring to “heel spur syndrome” when there is inflammation of fascia tissue and a heel spur is evident ,and “the beginning stages of heel spur syndrome” if a heel spur is not evident on the x-ray. When there is inflammation and pain in the plantar fascia only, the manual simply refers to the condition as “plantar fasciitis”.
Most doctors do not differentiate between plantar fasciitis and heel spur syndrome simply because there is no need to, however, they may use the plantar fasciitis on its own when there is pain along the plantar fascia but there is no heel pain or evidence of heel spurs.
What Causes Heel Spurs?
Heel spurs are most likely caused by an overload of tension in the plantar fascia, because heel spur syndrome is rarely seen unless there is an underlying case of planter fasciitis.
It sometimes seems that heel spur syndrome can be caused by so much pressure being placed on the big toe that it spreads throughout the plantar fascia and into the heel, but this is unlikely when you consider the amount of tension the arch of the foot is exposed to every day; it must carry twice our body weight in tension every time we push off from our back leg when walking. This makes it very likely that most fascial irritation begins in the arch of the foot and not in the big toe. Regardless of where the pressure starts once a case of plantar fasciitis develops it strongly increases the chances of heel spur syndrome developing as well.
This essentially indicates that anything that causes plantar fasciitis, such as having an unorthodox shape to the foot or overly tight calf muscles, is likely to lead to the development of heel spurs as well. It is little wonder then that heel spurs are nearly as common as plantar fasciitis, in fact, studies indicate that as much as 21% of the population may suffer from plantar fasciitis and that 30-70% of those people suffer from heel pain and have heel spurs as well.
Does It Matter?
So, is it plantar fasciitis or heel spur syndrome, and does it matter? For the general population (and for most doctors) the answer is no, it doesn’t matter, simply because heel spurs occur almost exclusively because of plantar fasciitis and both conditions are proscribed the same treatments. It may help to understand however, that heel spur syndrome is usually painless and that it is the inflammation that needs to be treated in order to alleviate discomfort.
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