Symptoms of heel spurs and plantar fasciitis

The most commonly reported symptoms are sharp heel pain on rising first thing in the morning and after rest.  Patients report a dull pain all day whether standing or walking.  Plantar fasciitis is most often seen in middle aged men and women, but can be found in all age groups.  The location of the pain can be anywhere on the underside of the heel commonly one spot is found as the main source of pain.  This can often be palpated four centimetres forward from the calcaneus and may be tender to touch.  When diagnosing heel spurs and plantar fasciitis the differential diagnosis’ to be consider should be:-

(a)    Entrapment of the medial and lateral calcaneal nerve.  Upon examination excessive over pronation in the affected foot the medial nerve may become trapped.  Pain radiates from the inside of the heel out towards the centre of the heel.

(b)    Tarsal tunnel syndrome.  The medial and lateral planter nerves running along the inside of the malleolus can be inflamed due to over pronation thus increasing the pressure on these nerves causing them to become inflamed.  The result is a sharp pain radiating into the arch of the foot, heel and sometimes the toes. 

(c)    Stress fractures of the heel.  Commonly found in runners and soldiers who do a lot of marching particularly on hard undulating surfaces.  Symptoms include insidious gradual onset of heel pain which is often made worse by weight bearing activities.  X-ray examination of the injured area may not show any signs of fracture until the fracture has actually started to heal which is two to three weeks later. 

(d)    Infection.  Soft tissue infection with or without abscesses is a possible cause of heel pain. 

Most clinicians explain heel spurs as traction due to a stretching of the plantar fascia.  This is not consistent with current research on the origin of the heel spur.