Heel hurts? You might think you have a heel spur — and it certainly may feel like something sharp is stabbing you in the bottom of your foot. But more than likely, you’re suffering from plantar fasciitis, not a heel spur. The good news is that with proper care, you can be pain-free fairly soon.
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Reason behind the pain
Plantar fasciitis is a painful inflammation of the fibrous band of tissue — called plantar fascia — that runs along the bottom of the foot. The plantar fascia connects the heel bone to the ball of your foot.
People with plantar fasciitis often experience a painful spot near the heel, says podiatrist Joy Rowland, DPM. People often mistake this pain for a heel spur. The conditions can be related, but not always, Dr. Rowland says.
“A lot of patients come into the office saying ‘I have heel pain, so I think I have heel spurs,’ but you don’t necessarily have to have heel spurs to have plantar fasciitis,” Dr. Rowland says.
In most cases, it’s not the heel spur or a bone causing pain, but rather inflammation of the plantar fascia ligament, Dr. Rowland says. In fact, plantar fasciitis is one of the most common causes of foot pain that brings patients to the podiatrist’s office.
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But sometimes too much pressure can damage or tear the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
In most cases, plantar fasciitis seemingly develops without any reason. But some factors can make you more prone to the condition:
- Tight calf muscles that make it difficult to flex your foot.
- Very high arch.
- Repetitive impact activity such as running.
- New or increased physical activity.
Many people develop heel pain after making a sudden change in foot gear, such as going from flats to heels or vice versa. People who spend a lot of time on their feet at work or who play sports also are susceptible, Dr. Rowland says.
When is it a heel spur?
A heel spur is a calcium deposit that creates a bony protrusion on the underside of the heel bone. Heel pain related to a heel spur occurs when the protrusion causes chronic inflammation of the soft-tissue tendons or fascia nearby.
At the same time, a heel spur may cause no symptoms at all. They often are discovered incidentally during x-ray exams taken for other purposes, Dr. Rowland says. One out of 10 people have heel spurs, but only one out of 20 of people with heel spurs have foot pain.
More than 90 percent of people with heel spurs get better with nonsurgical treatments. But if conservative treatment fails to relieve the pain from heel spurs after about a year, surgery may be necessary to relieve pain and restore mobility, Dr. Rowland says.
Dr. Rowland said the best way to treat plantar fasciitis is with proper stretching, applying ice, and using shoe orthotics for arch support. As with heel spurs, more than 90 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods such as these.
“Stretching is a big part of treatment for plantar fasciitis,” Dr. Rowland says. “We have to allow that ligament to stretch rather than pull.”
Dr. Rowland said people who have had plantar fasciitis in the past are more likely to get it again if they don’t continue to stretch.
“Exercising the foot ligaments and wearing supportive shoe gear are essential for staying pain-free,” she says.