Pain under the foot: plantar fasciitis or heel spur?

Your foot’s arch is supported by a fibrous membrane called the plantar aponeurosis or plantar fascia.

This membrane can become inflamed and even partially ruptured if it is subjected to excessive or uneven stress.

This is known as plantar fasciitis.

Nowadays, it is among the most common causes of heel pain in Canada.

If left unattended, plantar fasciitis can lead to the calcification of the fibrous membrane beneath the foot.

Eventually, this accumulation of calcium leads to a permanent bone deformity known as heel spur.

While inflammation similar to fasciitis will cause pain under the foot, this is not always the case with heel spur.

Let’s take a look at what other elements differentiate plantar fasciitis and heel spur.

What is plantar fasciitis?

Plantar fasciitis is more than just a pain under the foot; it is an inflammation of the fibrous tissue that links the heel and the forefoot.

It is particularly associated with impact sports and is responsible for 8% of running injury cases.

However, sports alone are not enough to result in the inflammation of this ligament that supports the foot’s arch.

Instead, it is due to biomechanical factors combined with poor lifestyle or training habits.

If plantar fasciitis is left unattended, it can worsen over time and even cause complications, such as:

Chronic pain;
A torn plantar fascia;
A calcaneus heel spur;
Joint and muscle pain due to musculoskeletal overcompensation.

In order to prevent this, it is crucial to be mindful of the symptoms associated with the development of plantar fasciitis.

What symptoms may point toward plantar fasciitis?

Current data suggests that plantar fasciitis is responsible for 3.6% to 7% of all cases of heel pain reported in the general population.

In addition, this injury has the peculiarity to manifest itself in various types of pain.

If you can relate to one or more symptoms listed below, it is possible that your condition is indeed plantar fasciitis:

Pain under the foot: the pain caused by plantar fasciitis is usually localized where the fascia meets the heel bone.
Fluctuating symptoms: spikes of pain tend to occur with the first steps of the day or after a period of time without exercise.
Pain when moving: the pain appears as an acute throbbing, and recurs while walking or any other activity that requires regularly lifting the heel.
Pain that deteriorates: if left untreated, the discomfort associated with plantar fasciitis can quickly get worse and even become chronic.
Swelling of the foot: fascia inflammation is sometimes accompanied by significant swelling near the painful area.
Bruising on the sole of the foot: when the fascia membrane ruptures, it manifests as a bluish discoloration. In this case, it is strongly recommended to see a doctor.

How is plantar fasciitis diagnosed?

The pain caused by plantar fasciitis can have several causes.

Therefore, a consultation in a podiatry clinic is crucial for choosing the appropriate treatment.

To devise a treatment plan adapted to the perceived discomfort, the podiatrist will resort to various diagnostic methods, such as:

The biomechanical exam: this procedure confirms the diagnosis of plantar fasciitis through tactile manipulations of the foot.
Digital radiography: the podiatrist uses this procedure only if they cannot make a diagnosis with the biomechanical exam.
Magnetic Resonance Imaging (MRI): the podiatrist or physician will usually order an MRI if they suspect a fascial tear.

It is possible that an examination, for example a digital radiography, will reveal the presence of a heel spur stemming from plantar fasciitis.

How can you prevent plantar fasciitis?

As it is the case with a variety of other inflammatory problems of the foot, plantar fasciitis results from poor biomechanical organization. The same is true for flat or cavus feet, for example.

However, there are also other aspects that can enable its development.

Therefore, to keep plantar fasciitis from deteriorating, you must make sure to adopt certain preventive behaviors:

Maintain a healthy weight: obesity or rapid weight gain exerts the stress on the plantar fascia fiber.
Walk shorter steps: this measure reduces the pain caused by the stress on the heel.
Avoid walking barefoot: walking without shoes puts more stress on the aponeurosis of the foot.
Wear high heels moderately: not only do they compress the foot, but they provide little support for the heels by making them unstable.
Use a quilted mat: especially for work that requires long hours in a static position, a soft surface relieves the legs and feet.

Seeing as plantar fasciitis is particularly widespread in athletes, you should include certain preventive measures in your training program:

Take adequate breaks between workouts: a high number of plantar fascia microtrauma can increase the incidence of fasciitis.
Temporarily reduce sports that impact the feet: activities such as jogging and hiking can be replaced with others, of moderate intensity on the feet, such as swimming and cycling.
Get in the habit of a good warm-up: being insufficiently warmed up can lead to a loss of flexibility in the fasciae.
Stretch properly after exercise: on top of relaxing the fascia and muscles of the foot, it is important to pay attention to the calf muscles and Achilles tendons.
Gradually increase the intensity and duration of exercise: the rapid change in athletic practices prevents the fasciae from properly adapting to the new stresses, thus making them more vulnerable.

Can your footwear influence plantar fasciitis?

In many cases, the wrong choice of footwear can exacerbate an already problematic condition.

This is particularly true for those who suffer from plantar fasciitis.

If you happen to be among the people at risk, you should choose shoes that meet the following criteria:

They are closed-toe: ballerinas or sandals offer negligible support to the arch of the foot and the heel.
They have heel pads: this helps to reduce the effects of weight shift when walking.
They have laces or Velcro straps: these types of straps pull the foot tight enough to provide sufficient support to the heel.
They are not too worn: worn soles are less effective at absorbing shock, especially in running shoes.
They are designed to fit the shape of the foot: if the shoe is too wide or too narrow, it will hinder movement and fail to provide the necessary support.

If you would like to maximize your comfort, you may insert custom foot insoles or heel pads into your shoes.

What types of physical exercise should you do to relieve plantar fasciitis?

Due to the fact that this ligament inflammation is the result of excessive tension, its treatment should include warm-up and stretching exercises for the injured foot.

The good news is that there is no shortage of exercise routines to help relieve the pain associated with plantar fasciitis.

Here are five exercises that will allow you to relax the various musculoskeletal structures that are part of a plantar fasciitis diagnosis:

Plantar fascia relaxation:

Take a tennis ball.
Put yourself in a sitting or standing position, depending on your preference.
Once you are in the correct position, apply pressure on the tennis ball by holding it under your aching foot without increasing the pain too much.
Roll the ball under your foot from heel to toe, back and forth.
Repeat the stretch for intervals of 5 minutes at 3 different times throughout the day.

Reinforcing the muscles of the foot:

Get a towel.
Sit on a chair and place your foot on the towel.
Bring it back to you and grasp it with your toes.
Put the towel back down and repeat the exercise 3 times.

Stretching the calf muscle:

Stand facing a wall and brace yourself against it with your hands.
Bring your healthy foot close to the wall, keeping the other leg straight.
Bend the knee of the healthy leg while tilting the hip towards the wall until you feel a stretch in the calf above the pained foot.
Hold this position for 30 seconds.
Do four repetitions of this stretch, 3 times a day.

Mobilizing the heel:

Get into a standing position with both feet on the floor.
Slightly lift the right foot’s tip and keep the heel flat throughout the exercise.
Imagine that your heel is a pencil and try to draw an “8” on the floor.
Repeat the process with your left foot.
Repeat the exercise for about 2 minutes, 2 times a day.

The forefoot stretch:

Sit on a chair.
Place your aching foot on the knee of the other leg.
Grasp the toes of this foot at their base.
Lift them up.
Hold this position for about ten seconds.
Use your thumb to check that your plantar fascia is properly stretched.
Repeat the movements with the other foot if necessary.
Perform the movement 10 to 20 times, 3 times a day.

Of course, the main goal of doing these exercises is to ease the tension that builds up in the calf, ankle and foot.

If they prove to be too painful to perform, they may just not be suited for your condition or plantar build.

The podiatrist will be able to suggest stretching exercises that are compatible with your condition.

How is plantar fasciitis treated in a clinic?

A podiatrist can treat your plantar fasciitis in a number of ways.

After previously diagnosing it in the clinic, they will set up a treatment plan, which may include:

Foot orthoses: By changing the load distribution, they reduce the tension exerted on the foot, which aggravates the plantar fascia.
Manual foot therapy: Using joint and muscle mobilization techniques, this treatment method restores flexibility to a tight plantar fascia.
Orthopedic shoes: Sometimes accompanied by orthotic insoles, custom orthopedic shoes provide additional support for painful feet.
Splints: These are used day and night to stretch and properly support the inflamed plantar fascia.
Physiotherapy: With a podiatrist’s recommendations, a physiotherapist can set up an exercise program to strengthen the muscles of the foot and calf.
Ultrasound: If the condition becomes chronic, applying sound waves to the injury will help soothe the pain and inflammation.
Wearing heel pads: A nice addition to your regular shoes, heel pads are a great way to temporarily increase the lack of support.
Shockwave therapy: This series of rapid shocks speeds up the natural healing process while improving blood circulation in the foot.
Therapeutic tape: Especially practiced by athletes, therapeutic taping seeks to fix poor joint alignment and reinforce the muscles of the foot.
Wearing a compression sleeve: It to the arch of the foot by reducing the width of the plantar fasciitis, thus allowing your foot better mobility.
Immobilizing the foot in a weight-relieving shoe: This can be applied in a hinged fashion, is less restrictive than a cast, and helps protect the foot from further injury.
Cortisone injection: It is used to reduce inflammation and reduce swelling. However, too much cortisone can make fasciitis worse, so this treatment should be used in moderation.
Foot surgery: As a last resort, it consists of reducing the tension of the plantar fascia by making an incision of a few millimeters.

As you can see, there is a wide variety of ways to treat plantar fasciitis and they can often complement each other.

Your podiatrist will be able to determine the severity of your injury and offer you a plan of treatment adapted to your situation.

Which people are the most at risk for developing plantar fasciitis?

Plantar fasciitis appears more commonly in athletes who play sports such as running or basketball.

It is also widespread in those who work standing up or have to walk long distances on hard surfaces.

Aside from these two, other factors can also contribute to the development of plantar fasciitis:

Obesity: the extra weight caused by a sedentary lifestyle increases the strain on the plantar fascia; the same is true for rapid weight gain such as during pregnancy.
Heredity: if a person inherits a problematic foot arch, such as a flat foot, they are more likely to be susceptible to this type of inflammation.
Inappropriate footwear: shoes that are worn or badly fitted to the shape of the foot can increase the risk of fasciitis, especially in active people.
Unusual plantar arch: flat and cavus feet result in instability that damages the plantar fascia.
Unfavorable posture: The imbalance caused by asymmetrical legs, the imbalance of the pelvis, or misalignment of the knees can increase the risk of plantar fasciitis.
Rheumatoid arthritis: this type of inflammatory arthritis weakens the joint structures of the foot, making it more susceptible to pathologies such as plantar fasciitis.
Poor training technique: pronation and postural imbalance are conditions that require proper training technique to avoid susceptibility to inflammatory conditions.
Injection of large amounts of corticosteroids: Although cortisone injection is also a form of treatment, too many injections can damage the plantar fascia.

What is heel spur?

Heel spur is a bony growth that occurs at the junction of the calcaneus and plantar fascia. It is also known as a Lenoir’s thorn and occurs in response to excessive stress on the plantar fascia.

In this regard, it is closely related to plantar fasciitis.

Actually, several studies suggest that nearly 50% of people with plantar fasciitis will suffer from heel spur during their lifetime.

However, Lenoir’s thorn does not always come as a result of plantar fasciitis.

In fact, 16% of people develop a heel spur without having previously suffered from plantar fasciitis.

Nevertheless, the factors responsible for heel spur remain very similar to those that cause plantar fasciitis.

Here are some of the things that contribute to the occurrence of this bony growth:

Flat or cavus feet;
A lack of flexibility of the plantar arch;
Prolonged walking or running on uneven surfaces;
A lack of muscle flexibility;
Uneven lower limbs;
An unstable ankle;
Ageing, which causes the thinning of the plantar cushion;
Excessive pronation;
The use of improper footwear.

Is heel spur a pathology or simply a complication of plantar fasciitis?

In the majority of cases, the subtle symptoms of heel spur make it difficult to consider it a pathology.

It can actually happen that a heel spur is discovered on a digital radiograph without the patient being alerted by any symptoms.

Despite its peculiar nature, heel spur is not a disease.

Instead, it is to be taken as a warning from the body trying to correct the imbalance caused by chronic plantar fasciitis.

Although the bone growth is usually without symptoms, the inflammation that accompanies it can sometimes cause acute pain when the foot hits the ground.

If this is the case, it may be a good idea to consult a podiatrist to determine the cause of the inflammation.

How to diagnose heel spur?

Seeing as just palpation is not sufficient to determine the presence of heel spur, a consultation at a podiatry clinic is usually necessary for a conclusive diagnosis.

The Lenoir’s thorn is usually diagnosed with technologies such as:

Radiography: This method is the most effective in detecting bone defects.
Ultrasound of the foot: This technique aims to identify the exact location of the spur and any soft tissue damage it may have caused.

How can one treat heel spur?

As stated before, heel spur is just one of the consequences of plantar fasciitis left untreated.

Since it is usually painless, Lenoir’s thorn rarely results in problems for the affected.

However, if you experience severe inflammatory pain or stiffness in the heel, you can take certain measures to alleviate it.

Among other things, you should consider:

Temporarily refraining from sports activities: By sparing the heel, the plantar fascia will not be subjected to even more tension, thus avoiding a possible tear.
Ice application: Applying a cold compress will help reduce swelling in the foot or soothe the inflammation that is causing discomfort.
The moderate use of painkillers: Ibuprofen, naproxen and aspirin temporarily relieve pain, but should be used in moderation.
Weight loss: Since obesity increases the effects of biomechanical problems in the foot, reducing body weight can decrease plantar fascia tension.

While these methods are a good way of temporarily relieving the discomfort caused by inflammation, you should still make sure to see a podiatrist without delay, in order to prevent the situation from getting worse.

Does heel spur disappear after treatment?

Once heel spur has developed, unfortunately it cannot subside naturally.

Non-invasive treatments such as therapeutic taping or splints may reduce inflammation, but only foot surgery can truly remove Lenoir’s thorn.

However, it is worth mentioning that surgical removal of the bony growth is a last resort.
Also, seeing as the spur tends to grow back, podiatrists usually recommend conservative measures such as prescribing foot orthoses or shockwave therapy.

PiedReseau has 40 clinics to help treat your heel pain

Whether you are an athlete or a more sedentary person, your heels are responsible for performing important functions in maintaining balance and absorbing shock.

Therefore, when you suddenly start suffering from a stabbing pain in the heel, it can affect your entire posture.

Without immediate intervention, the pain caused by plantar fasciitis can deteriorate and even become chronic.

Aside from your discomfort, your plantar fasciitis can also lead to a permanent bony growth like Lenoir’s thorn.

You can also expect that a few lifestyle adjustments will provide temporary relief.

However, inflammation and ossification of the plantar fascia should not be taken lightly.

The podiatrist can analyse your situation and determine what is causing your condition with the diagnostic tools at their disposal.

If you experience heel pain, you’d better contact your PiedReseau podiatrist.