Do you have intense heel pain with your first steps in the morning? Do you question if it's a heel spur or plantar fasciitis?
I have treated hundreds of cases of heel pain, arch pain, and plantar fasciitis in my 23 years of private practice. When patients present with foot pain, the first and most important step is to determine what is causing their pain and offer a correct diagnosis.
Plantar fasciitis and heel spurs are two different conditions, however, they are commonly confused because they share very similar symptoms.
A heel spur is the presence of a sharp protrusion that forms on the surface of the heel, while plantar fasciitis is the inflammation and degeneration of the plantar fascia.
Let's take a closer look at each condition and their similarities and differences.
Dr. Angela Walk
The Plantar Fasciitis Doc
What Is The Difference In Plantar Fasciitis And Heel Spurs?
The most profound distinction between a heel spur and plantar fasciitis is that heel spurs may not cause pain, while plantar fasciitis usually always does. However, the specific site of pain can be different.
While pain from plantar fasciitis is typically present in the foot arch and on the medial (inside) of your calcaneus bone (heel bone), pain due to heel spurs is more localized to the center of the heel bone.
Also, the pain with plantar fasciitis is typically a sharp, burning sensation and heel spurs cause a stabbing pain and a dull ache throughout the day.
Plantar Fasciitis Symptoms:
Plantar fasciitis is developed when you overwhelmed the structural integrity of the plantar fascia and create inflammation and degeneration. (ill-fitting footwear, excessive physical activity, prolonged standing, foot and ankle inflexibility)
Sharp pain on the bottom of the foot or near the inside portion of the heel. It is often worse with the first steps in the the morning or after a period of rest. It often improves as the fascia is stretched throughout the day.
Discomfort when stretching the foot, especially with extension of the big toe.
Increased pain after exercise or activity.
Heel Spur Symptoms:
Heel spurs are the product of repeated trauma and damage to the foot muscles and heel ligaments. They are commonly caused by walking or running with poor form, over-exercising on hard surfaces, and wearing ill-fitting footwear.
Stabbing sensation and point of tenderness in the center of the heel that is worse in the morning or after rest.
A dull ache in the heel throughout the day.
Confirmation of the presence of a heel spur is made with an X-ray. A heel spur can be up to 1/2 inch in length.
Increased pain while walking without footwear
What Causes Heel Spurs?
Heel spurs are a build up of calcium deposits on the heel bone. They can build up over several months’ time without causing pain.
A frequent misconception is that heel spurs are the most common cause of heel pain. However, pain from heel spurs in only present in 5% of the people who have heel spurs. In fact, heel spurs are considered a normal finding on an X-ray.
According to the American Association of Orthopedic Surgeons (AAOS), 1 in 10 people has a heel spur, while only 1 in 20 individuals with heel spurs experience pain.
Plantar fasciitis, on the other hand encompasses a broader range of symptoms and will always cause a localized pain in the foot and heel area. An aching, burning pain in the heel first thing in the morning that eases up as you keep walking is a hallmark sign of plantar fasciitis.
It’s also possible to have both at the same time, although this isn’t always the case, since many individuals with plantar fasciitis do not have a spur despite the presence of heel pain.
Can You Have Heel Spurs Without Plantar Fasciitis?
Heel spurs are the product of repeated trauma and damage to the foot muscles and heel ligaments. As a result, they can occur even without plantar fasciitis, and plantar fasciitis can also occur without heel spurs.
Can Heel Spurs Cause Plantar Fasciitis?
A common misconception is that heel spurs cause plantar fasciitis. This is simply not true. Cadaveric studies have shown that the plantar fascia is not attached to the heel spur on the bottom of the heel.
In fact, many people have heel spurs without the pain of plantar fasciitis. Thus, the notion that heel spurs cause plantar fasciitis is a myth and is unfounded. Also, plantar fasciitis doesn’t cause the growth of heel spurs.
Causes & Solutions Of Plantar Fasciitis & Heel Spurs
The same risk factors and causes predisposing you to plantar fasciitis also increase your risk of developing heel spurs. Let's look at the most common causes that increase the chances of developing either plantar fasciitis or heel spurs.
(1.) Limited Dorsiflexion and Limited Ankle Mobility:
People with plantar fasciitis and heel spurs typically have trouble with dorsiflexion (flexion of the foot). That’s the movement in which the foot is brought toward the shin. In other words, tight calf muscles. Limited dorsiflexion can also be from decreased ankle mobility.
When dorsiflexion is limited, it places a tremendous strain on the heel and puts the plantar fascia under perpetual tension.
AIS is a specific type of stretching where you hold the stretch for only 2 seconds and perform 10 repetitions. Stretch 3 times per day for best results.
Calf raises is the easiest way to begin to strengthen the gastroc/soleus complex. Placing a ball between your heels targets a specific muscle that helps create arch strength and stability.
(2.) Obesity or overweight
Since your arches bear your body’s weight and serve as your body’s shock absorbers, anything that increases the stress on your feet can alter biomechanical functions, thereby increasing your risk of developing PF or heel spurs.
Obesity is a factor in 70% of plantar fasciitis cases. In some cases, gaining weight quickly can cause PF to develop. (For example, pregnancy).
Solution: Manage your weight and consider an anti-inflammatory diet. Many people don't realize that certain foods can actually make PF worse.
Avoid inflammatory foods such as sugary foods, processed foods, grains and gluten. Also, dehydration can exacerbate you symptoms. Drink half your body weight in ounces of water.
(3.) Ill-fitting Footwear: Improper shoes
Poor footwear is one of the leading causes of foot and ankle disorders including plantar fasciitis. Most of our footwear today are tapered at the toe. Over time, our feet conform to the narrowed shape and this creates deformity.
No wonder we suffer from foot pain, bunions, and other gait related issues. Feet are a product of their environment. The shape of the footwear that you wear most often can actually begin to change and shape the structure of your feet.
It's not just women's high heels, it's also running shoes, men's shoes, and casual shoes. They are all tapered at the toe.
Solution: To avoid deformity, wear footwear with a wide toe box so our feet can spread and splay at the forefoot. Minimalist shoes are the best option and are made to accommodate the normal shape of our feet and closely mimic barefoot walking. Find my complete list of Approved Shoes For Plantar Fasciitis here.
(4.) Weak Intrinsic Foot Muscles:
The smaller muscles of the foot and arch often are weak and contribute to fallen arches and poor foot mechanics. It's critical to strengthen these weak muscles to truly heal.
If you’ve got dysfunctional or weak intrinsic foot muscles, your foot will start to rely too much on surrounding musculature – including the plantar fascia.
Solution: My first line of defense with plantar fasciitis is to teach my patients how to use their own muscles, the intrinsic muscles of the foot to support their foot.
A combination of stretches and strengthening exercises can be incorporated when treating plantar fasciitis and heel spurs. Find the most effective exercises here.
(5.) Prolonged or Sudden Strain
Prolonged repetitive activities requiring you to stand on your feet for a long period of time daily, or high-impact sporting activities like running, jumping, and hiking can all increase your chances of developing these conditions.
You can also develop PF or heel spurs from a sudden change or increase in your physical activity levels. Such as a runner increasing your miles suddenly, or and extended period of prolonged standing or walking.
Solution: Rest and ice deal directly with the pain and inflammation but do not address the cause. Listen to your body and avoid putting additional stress on your foot as it is healing. Try running and walking on softer surfaces
Can I Treat Plantar Fasciitis At Home?
If you have this debilitating condition, here are my top 3 recommendations.
Download my free guide. This is the first step on your PF recovery journey. I show you the exact steps to resolve plantar fasciitis at home.
Take a look at my approved footwear guide. Dr. Angela's Recommended Shoe List and make sure you are not sabotaging your recovery with wearing the wrong shoes.
Because there is a so much misinformation out there about plantar fasciitis, I spend most of my time educating people on what NOT to do.
Most rehabilitation efforts fail because they are relying on cortisone shots, night splints, orthotics, ineffective stretching, thick, cushiony shoes, and rolling on a frozen water bottle.
These methods are either ineffective or just short-term band-aids, and do not provide long-term correction.
In my (6) step free guide, I offer solutions through addressing multiple factors. Improving footwear, identifying areas of weakness in the foot and ankle, and restoring proper foot function.
Because heel spurs and plantar fasciitis display very similar symptoms, it can be difficult to determine the source of your pain. I hope this article has given you the information you need to reach a proper diagnosis.
The good news is that up to 90% of patients succeed in eliminating their pain with conservative treatment instead of cortisone shots or surgery. Implement the protocols mentioned above for proven, pain-relieving results.
If you are dealing with the pain of heel spurs or plantar fasciitis, it doesn’t have to be life changing. By arming yourself with knowledge and taking charge of your healing, you can get back to the activities you love and feel like yourself again.
If you have additional questions about your foot health, do not hesitate to reach out. I'm here to help get you back on your feet--literally.
Best Of Health,
I've written extensively on the topic of Plantar Fasciitis. Take a look at these other related blog posts:
Hi, I'm Dr. Angela Walk...
I have been involved in the health and wellness industry for over 20 years as a health & wellness physician and chiropractor. I specialize in foot and gait mechanics. I have written extensively for health publications and I am keenly aware of trends and new developments in natural health.
I embrace an active lifestyle combining diet, exercise and healthy choices. My goal is to inform my readers of natural options available to them in hopes of improving their health and quality of life.