Heel pain and everything you need to know about spur and plantar fasciitis

Many runners, hikers, football players, and other athletes have struggled with heel pain in their lives. Most of us then seek comprehensive information about why this pain bothers us and what causes it. Since we have encountered it as well, here is a summary of the basic information about heel spurs and plantar fasciitis that you should know if you are deciding how to further address the injury.

Summary:

1. Heel pain can be caused by a variety of factors, including Achilles tendonitis, plantar fasciitis, or the development of a spur on the heel bone;
2. A spur is a small growth on the heel bone that can result from inflammatory changes in the plantar fascia;
3. Plantar fasciitis is an inflammation of the plantar fascia of the foot that is often the result of overuse. This injury can be associated with age, improper footwear, obesity, or intense athletic activity;
4. Treatment for plantar fasciitis and spurs includes rest, stretching, massage, orthotic inserts, medication, and, in extreme cases, surgery. Stretching and massage can be done at home, but it is important to seek a doctor for a proper diagnosis and treatment plan;
5. Recovery time is individual, but most patients experience pain relief within 10 months of starting treatment. Athletes should gradually increase the load and return to training only after full recovery.

Why does my heel hurt?

If you've injured yourself with one hard impact, it's probably a fracture or injury to a ligament, muscle, or tendon. If your pain developed gradually over a period of weeks and got worse, you need to understand where your heel hurts. Back heel pain is usually caused by Achilles tendonitis or inflammation of the calcaneal spine (called bursitis). Plantar fasciitis is the most common cause of lower heel pain, leading to spurs (1).

What are spurs and plantar fasciitis?

Spur is a small growth on a bone. It is most often found on the roughened heel bone. It usually measures around 1-2 millimetres and is very painful. The spur is very closely related to plantar fasciitis (2).

Why does plantar fasciitis occur?

Plantar fasciitis is not uncommon in the elderly, obese people, people with a faulty gait, people with inappropriate footwear, and athletes. What these groups of people have in common is that they have subjected their feet (and therefore the plantar fascia) to excessive stress. When stress is applied, microtrauma occurs. When the load is at a reasonable level, the tissues will regenerate and become stronger and firmer. If the load is excessive and the microtraumas fail to regenerate, tissue degeneration occurs, which prolongs healing and causes soreness. This is called plantar fasciitis in the plantar fascia (3).

How does plantar fasciitis lead to spurs?

The plantar fascia has its beginnings on the heel bone. When it is inflamed, the fascia even deposits calcium at its origin, the heel bone, creating a growth on the heel that we call a spur (2).

Typical manifestations of heel spurs

Plantar fasciitis typically manifests itself in the morning when getting out of bed. Patients describe the pain as stabbing and localized in the foot and heel. The pain in plantar fasciitis improves with walking and activity but returns with the first movements after prolonged rest. In spurs, the pain is similar to that of plantar fasciitis but does not subside as easily with movement. Palpation of the bottom of the heel is also painful.

What to do with plantar fasciitis and spurs

• When these injuries are suspected, it is of course necessary to see a doctor (orthopedist) who can confirm or refute the diagnosis.
• For plantar fasciitis, the doctor will recommend rest for the foot and stretching of the fascia and may prescribe orthotic inserts, a brace, or medication.
• For a very painful spur, an anti-inflammatory medication will be prescribed. In some cases, the doctor can also choose to proceed with a corticosteroid injection. Only after the acute phase of the disease passes and the condition of the foot has stabilized a little can it be reasonable to start stretching. If conservative therapy fails, surgery is necessary (1).

What exercises are advisable?

• Stretching the plantar fascia directly seems to be the most effective. Put your foot over your foot (sore on top), grab your big toe, and pull it towards your shin for 15 to 30 seconds.
• You can also try a gentle foot massage by rolling your foot over a massage roller or perhaps a bottle or tennis ball.
• Stretching the calf can also be helpful by leaning against a wall, putting your injured foot behind you, heel on the floor, and shin at an angle where your calf is stretched.
• You can also try pulling the toe of the foot towards you with a towel under the toe (4).

How long does the treatment take? How long before I can train again?

Each treatment is individual, depending on the patient's healing ability and how early the injury was discovered. Early-treated faciitis can disappear in a few weeks. In 90% of all facitides and spurs (including the most severe ones), the pain completely goes away within 10 months of stretching and a lighter regimen (5).

As athletes, our primary concern is when we can return fully to training. There are no specific numbers on this. We need to be mindful of our bodies and start training gradually and with ease. The main thing is to wait until the pain goes away and you can load the leg with your normal life. Then you can start trying to gradually increase the load and return to training. The important thing is to stick to the principles that you must not train through the pain and leave enough room for recovery between training sessions, preferably a few days. We all want to get back into training as soon as possible, but in this case, patience pays off.

References:

1. Agyekum, Edward Kwame, and Kaiyu Ma. “Heel pain: A systematic review.” Chinese journal of traumatology = Zhonghua chuang shang za zhi vol. 18,3 (2015): 164-9. doi:10.1016/j.cjtee.2015.03.002
2. Kirkpatrick, Joshua et al. “The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.” Journal of anatomy vol. 230,6 (2017): 743-751. doi:10.1111/joa.12607
3. Trojian, Thomas, and Alicia K Tucker. “Plantar Fasciitis.” American family physician vol. 99,12 (2019): 744-750
4. https://www.healthline.com/health/fitness-exercise/plantar-fasciitis-stretches
5. https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs