There’s a lot of confusion about where heel pain comes from. In particular, two conditions crop up a lot when we talk with patients about their symptoms and results—plantar fasciitis and heel spurs. It is true that these conditions often appear together, and therefore are closely associated with one another. But when it comes to heel pain, one of them is a much bigger problem than the other.
Do you know which?
First, let’s talk about how and why plantar fasciitis and heel spurs are related. At the most basic level, both tend to form as a response to repeated force and pressure along the underside of the heel over an extended period of time. Plantar fasciitis comes first; overuse causes the fibrous plantar fascia tissue along the underside of the heel and arch to stretch, tear, or degenerate. Heel spurs come next—this trauma to the plantar fascia can cause the tissue to pull away from the heel bone, which provides an opportunity for jagged, bony deposits of calcium to form.
So even if plantar fasciitis is bad, heel spurs must be worse, right? Given how the former tends to directly cause the latter, one might suspect that spurs are the proverbial final right cross in a one-two combo. It certainly sounds like having a bony spike jutting from your heel bone would be pretty painful. But contrary to popular belief, most of the time heel spurs don’t cause any pain at all!
It’s the stretching and tearing in the soft tissues that really causes the most discomfort, and that means plantar fasciitis is almost always the real culprit. Effectively treating your plantar fasciitis won’t remove the spur, but over 90 percent of the time it will remove all your pain. As a matter of fact, we often detect heel spurs during X-ray examinations for completely unrelated conditions like bunions or ankle sprains, even when no heel pain is present. They’re more a hidden reminder of a previous struggle with heel pain than an ongoing problem.
That said, there are rarer cases when a particularly large or inconveniently positioned heel spur does cause pain and must be treated or removed.