In continuing the topic of plantar fasciitis, we can’t forget about the differential diagnosis associated with plantar fasciitis and heel pain. There are many associated with heel pain including localized nerve entrapments and neuritis, stress fractures, bone bruises, bursitis, radicular pain, Haglund’s deformity, Achilles insertional enthesopathy, retrocalcaneal bursitis, and of course heel spurs. Let’s focus on that last one, in particular spurs on the bottom of the heel.

We all know somebody who as patients or as friends has said to us “I think I have a heel spur.” My usual response to that statement is “why do you think that?” Their response is then “because it feels like I am stepping on a nail.” And then what follows of course is a conversation or interview about the person’s symptoms.

Most of us in my profession understand that heel spurs on the bottom of the heel rarely cause pain. Certainly I am generalizing as there are some that do cause pain but these are infrequent. The layperson may be confused by this. They come into my office carrying x-rays with them stating that they have a heel spur as told to them by their primary care physician or somebody else. And when I look at their x-rays, BAMM! There it is! A heel spur. Upon performing a thorough history and physical, performing x-rays, ultrasound, and ruling out other differential diagnosis, we have narrowed it down to either plantar fasciitis, or the heel spur as the etiology of their pain. Some of my patients look at me confused when I tell them I don’t think their heel spur is hurting them. Sometimes they don’t believe me until I explain it to them.

A discussion of the foot mechanics and function of the plantar fascia ensues. I also explain to them that I have many patients who come in with this same type of pain and they have no heel spur visible on x-ray. Therefore, how do you explain their pain if they have no heel spur? Or, some of my patients will say “but my mother had this problem and she had her heel spur removed. This solved her pain.” I then have to explain to the patient that removing the heel spur involves releasing the plantar fascia from the heel to get to the heel spur. It turns out that the plantar fascia release is actually what alleviates the pain, and not the removal of the heel spur.

So maybe you or somebody you know has a heel spur. Or maybe they have plantar fasciitis. That being said though, a thorough history and physical evaluation at Absolute Foot Care Specialists of Las Vegas is important to make sure this is truly the diagnosis and that you get the best care for your heel pain.

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