Q: What is a heel spur?

A heel spur is a bony growth on the bottom of the heel bone. Interestingly, research shows that not all heel spurs cause pain and that heel pain can completely resolve even when a heel spur is still present. Doctors sometimes use the diagnosis “heel spur” as a synonym for plantar fasciitis. This isn’t a problem, as the two conditions are related, share similar symptoms, and are treated the same way.

Q: What type of heel pain can I treat with this plan?

If you’ve been told you have plantar fasciitis and a heel spur, don’t worry — either plan will work. Heel pain often has more than one cause, so we’ve designed both rehab plans to cover all the bases. If you have any of the following diagnoses, the Heel Spur Rehab Plan in the Exakt App is suitable for you: Plantar fasciitis: An overuse injury of the plantar fascia Heel spur: The spur itself won't go away with physiotherapy, but the associated pain can be managed with our rehab plan

Q: What causes heel spurs?

How plantar fasciitis and heel spurs are linked Plantar fasciitis is an overload injury that develops when the force passing through your foot exceeds what the plantar fascia can handle. Bony spurs — like heel spurs — can form anywhere there’s too much pressure or strain on a bone. It’s thought that heel spurs develop when an overloaded plantar fascia pulls excessively on its attachment to the heel bone. What causes the overload? Activities that can increase the forces through your feet and cause heel pain include: Running, walking, or standing a lot in unsupportive shoes Running, walking, or standing on hard surfaces like concrete Carrying heavy objects or gaining weight Suddenly increasing your running or walking volume Weak foot and leg muscles Excessively tight muscles in the back of your legs (glutes, hamstrings, calves) Perimenopause or menopause may also contribute to plantar fasciitis. This is because lower estrogen levels reduce your body’s ability to produce and repair collagen fibers. Since collagen is the primary building block of the plantar fascia, the drop in collagen production and repair can increase your risk of developing plantar fasciitis.

Question 1

What is a heel spur?

Accepted Answer

A heel spur is a bony growth on the bottom of the heel bone. Interestingly, research shows that not all heel spurs cause pain and that heel pain can completely resolve even when a heel spur is still present.

Doctors sometimes use the diagnosis “heel spur” as a synonym for plantar fasciitis. This isn’t a problem, as the two conditions are related, share similar symptoms, and are treated the same way.

Question 2

Heel spur or Plantar fasciitis?

Accepted Answer

Did you know that researchers are now advising against using the terms “plantar fasciitis” and “heel spur” to describe heel pain?

They believe these diagnoses are outdated and not all that accurate.

Plantar fasciitis traditionally refers to an overuse injury of the plantar fascia and typically shows up as a thickening of the tissue on scans.

Heel spurs are small bony growths that form under the heel bone – usually triggered by overuse or poor foot mechanics. While spurs sound like they should be painful, studies have shown that many people have heel spurs without even knowing it – so they don’t necessarily cause pain.

But researchers point out that people who experience the typical heel pain we tend to label as “plantar fasciitis” or “a heel spur” usually have multiple structures in that area that are irritated or injured. So you can’t really blame just one of them for the pain.

The better term or diagnosis to use is “plantar heel pain”, which simply means pain under the heel that can come from several different structures.

How does this influence treatment?

The same treatments that help with “plantar fasciitis” also work for “heel spur.”

What’s important is that the treatment is tailored to your pain and your stage of recovery. The Exakt app gives you the tools and guidance to move forward at the pace that’s right for you.

Question 3

What type of heel pain can I treat with this plan?

Accepted Answer

If you’ve been told you have plantar fasciitis and a heel spur, don’t worry — either plan will work. Heel pain often has more than one cause, so we’ve designed both rehab plans to cover all the bases.

If you have any of the following diagnoses, the Heel Spur Rehab Plan in the Exakt App is suitable for you:

Plantar fasciitis: An overuse injury of the plantar fascia
Heel spur: The spur itself won't go away with physiotherapy, but the associated pain can be managed with our rehab plan

Question 4

Typical Symptoms

Accepted Answer

When heel spurs do cause symptoms, they tend to feel very similar to plantar fasciitis.

Since the underlying causes and treatments are the same for both conditions, it’s not a major concern if you’re not completely sure which one is behind your heel pain.

The most common symptoms include:

The pain is mainly located close to the heel and in the inner part of the foot arch, where the plantar fascia attaches to the heel bone.
It’s usually not associated with pins and needles, tingling, or numbness — if you have any of these symptoms, it’s likely something else.
You may notice some puffiness or swelling in the area of the inner arch, under the foot, but it will not cause swelling around your ankle or on top of your foot.
It doesn’t hurt while you’re sleeping or lying down.
The first few steps in the morning will likely be the most painful and stiff, and it is common for people to hobble around until their foot warms up.
If you sit still for long periods during the day, your foot may feel stiff and painful when you start walking again.
Standing still in one spot can be very uncomfortable.
Discomfort with walking and running can vary depending on how irritated your heel is. In mild cases, you may find that it hurts a bit to start, then feels OK when it warms up, only to hurt more afterward. In severe cases, however, you’ll likely find that the more you walk or run, the worse the pain gets.

Other conditions often misdiagnosed as plantar fasciitis or heel spurs include tarsal tunnel syndrome, stress fractures of the heel bone, and heel fat pad irritation.

Question 5

When to see a doctor

Accepted Answer

You should consult your doctor or physical therapist before using the app to ensure you have the correct diagnosis and are ready to start rehab exercises. If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

You feel a sudden sharp pain in your foot during activity — this may mean you've strained or torn something, and the App's program may no longer be appropriate
Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain — these signs can indicate a blood clot, and you should have it investigated as soon as possible
You have pain at night that keeps you awake or interrupts your sleep
You feel pins and needles or tingling in your leg or foot — this can indicate an injured nerve, and our rehab plan may not suit you
Your symptoms are getting worse
Your injury is not recovering as expected (see expected recovery times below)

If you have a chronic condition, e.g., osteoporosis, heart disease, or an inflammatory condition, the rehab plans in the app are likely not appropriate for you. Please check with your doctor before using the app.

Question 6

What causes heel spurs?

Accepted Answer

How plantar fasciitis and heel spurs are linked

Plantar fasciitis is an overload injury that develops when the force passing through your foot exceeds what the plantar fascia can handle.

Bony spurs — like heel spurs — can form anywhere there’s too much pressure or strain on a bone. It’s thought that heel spurs develop when an overloaded plantar fascia pulls excessively on its attachment to the heel bone.

What causes the overload?

Activities that can increase the forces through your feet and cause heel pain include:

Running, walking, or standing a lot in unsupportive shoes
Running, walking, or standing on hard surfaces like concrete
Carrying heavy objects or gaining weight
Suddenly increasing your running or walking volume
Weak foot and leg muscles
Excessively tight muscles in the back of your legs (glutes, hamstrings, calves)

Perimenopause or menopause may also contribute to plantar fasciitis. This is because lower estrogen levels reduce your body’s ability to produce and repair collagen fibers. Since collagen is the primary building block of the plantar fascia, the drop in collagen production and repair can increase your risk of developing plantar fasciitis.

Question 7

How do you treat heel spur-related pain?

Accepted Answer

While evidence suggests that the same treatments work for both plantar fasciitis and heel spur-related pain, there isn’t one approach that works for everyone.

What works for you will depend on the underlying cause of your symptoms – and combining different treatments usually gives the best results.

The following home treatments have been shown to help:

Relative rest: Cut out aggravating activities and reduce your training program to allow your pain to settle
Cushioned shoes and insoles with arch support: These are especially helpful if you spend a lot of time standing or walking on hard surfaces
A slow, progressive strength training plan: Gradually restore your plantar fascia's load tolerance, targeting your foot muscles
General strength and control exercises: Condition your core and other supporting muscles (glutes, hamstrings, and calf muscles) to help share the load when you walk, run, and jump
Mobility and range of movement exercises: Gain and maintain good flexibility in your glutes, hamstrings, and calf muscles to reduce the pull on your plantar fascia
Plantar fascia stretches: Not too aggressive as they can irritate your injury
Self-massage of the plantar fascia and other leg muscles: May help relax the muscles and reduce pain

The rehab plan in the App includes all of these components. It starts with low-load exercises that help settle your pain, then slowly increases the exercise intensity as your foot strengthens and heals.Other treatments you may encounter:

Night splints can be helpful in some cases
Taping to support the arch of your foot can reduce pain — if you find this helps, you may benefit from using supportive insoles in your shoes
Losing weight can reduce the load on your plantar fascia
Shockwave treatment may help to reduce pain in chronic cases
Corticosteroid injections can reduce pain in the short term but may interfere with long-term recovery and are generally not advised

Question 8

How long will my recovery take?

Accepted Answer

If you respond quickly and start with the right treatments within a few weeks of experiencing your first symptoms, it is possible to fully recover within 12 weeks.

But, if you ignore your heel pain and carry on with your usual activities, it can take 12 months or longer to resolve.

Question 9

How can I avoid getting heel pain?

Accepted Answer

You may reduce your chances of getting heel pain if you:

Wear supportive shoes
Do regular strength training for your core and general leg muscles
Avoid sudden increases in training volume and intensity
Avoid sudden weight gain or if you have gained weight, take steps to temporarily reduce the impact during your training sessions
Transition slowly and run only short distances when switching to less supportive, minimalist shoes
Adjust your training when you enter perimenopause to compensate for the changes in collagen production

Once you’ve completed your rehab, switch to one of the running training plans in the App — we’ve designed them with all these elements in mind.

Question 10

Do I need surgery to remove the heel spur?

Accepted Answer

No, studies indicate that removing a heel spur doesn't improve surgical outcomes for heel pain. That means you may still have heel pain even if you have surgery to remove a heel spur.

Studies also show that many people with heel spurs don’t have any heel pain. This highlights that heel spurs alone don’t cause pain and that you can fully recover even if you have one.

Question 11

Research references

Accepted Answer

Babatunde, O. O., et al. (2019). "Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis." British journal of sports medicine 53(3): 182-194.
Belhan, Oktay, Mehmet Kaya, and Murat Gurger. “The thickness of heel fat-pad in patients with plantar fasciitis.” Acta orthopaedica et traumatologica turcica 53.6 (2019): 463-467.
Bolívar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int. 2013 Jan;34(1):42-8. doi: 10.1177/1071100712459173. PMID: 23386760.
Caratun R, Rutkowski NA, Finestone HM. Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Can Fam Physician. 2018 Jan;64(1):44-46. PMID: 29358253; PMCID: PMC5962984.
Chen, C.-M., et al. (2018). "Comparative efficacy of corticosteroid injection and non-invasive treatments for plantar fasciitis: a systematic review and meta-analysis." Scientific reports 8(1): 1-9.
Cheung RT, Sze LK, Mok NW, Ng GY. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis. J Sci Med Sport. 2016 Sep;19(9):713-5. doi: 10.1016/j.jsams.2015.11.004. Epub 2015 Nov 22. PMID: 26655866
Cotchett, M., Rathleff, M.S., Dilnot, M. et al. Lived experience and attitudes of people with plantar heel pain: a qualitative exploration. J Foot Ankle Res 13, 12 (2020).
DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003 Jul;85(7):1270-7.
Drake, C., et al. (2022). "Medical imaging for plantar heel pain: a systematic review and meta-analysis." Journal of foot and ankle research 15(1): 1-18.
Elataar FF, Abdelmajeed SF, Abdellatif NMN, Mohammed MM. Core muscles’ endurance in flexible flatfeet: A cross – sectional study. J Musculoskelet Neuronal Interact.
Elvan A, Simsek IE, Cakiroglu MA, Angin S. Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle. Acta Orthop Traumatol Turc. 2019;53(2):145-149.
Garrett TR, Neibert PJ. The effectiveness of a gastrocnemius-soleus stretching program as a therapeutic treatment of plantar fasciitis. J Sport Rehabil. 2013 Nov;22(4):308-12. doi: 10.1123/jsr.22.4.308. Epub 2013 May 22. PMID: 23752554.
Gaurav, W., et al. (2020). "Plantar fasciitis: Evidence-based review of current treatment modalities." International Journal of Orthopaedics 6(2): 510-512.
Grieve, R. and S. Palmer (2017). "Physiotherapy for plantar fasciitis: a UK-wide survey of current practice." Physiotherapy 103(2): 193-200.
Hasegawa, M., et al. (2020). "Current concepts of minimally invasive treatment options for plantar fasciitis: A comprehensive review." Current Pain and Headache Reports 24(9): 1-11.
Harty J, Soffe K, O’Toole G, Stephens MM. The role of hamstring tightness in plantar fasciitis. Foot Ankle Int. 2005 Dec;26(12):1089-92. doi: 10.1177/107110070502601215. PMID: 16390645.
Harutaichun P, Boonyong S, Pensri P. Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis. Phys Ther Sport. 2021;50:130-137.
Jam, Bahram. “Evaluation and retraining of the intrinsic foot muscles for pain syndromes related to abnormal control of pronation.” Advanced Physical Therapy Education Institute 21 (2006): 1-8.
Kaiser, P. B., et al. (2018). “Stress fractures of the foot and ankle in athletes.” Foot & Ankle Orthopaedics 3(3): 2473011418790078.
Lai Z, Pang H, Hu X, Dong K, Wang L. Effects of intrinsic-foot-muscle exercise combined with the lower extremity resistance training on postural stability in older adults with fall risk: study protocol for a randomised controlled trial. Trials. 2021;22(1):587. Published 2021 Sep 3.
Lee JH, Park JH, Jang WY. The effects of hip strengthening exercises in a patient with plantar fasciitis: A case report. Medicine (Baltimore). 2019;98(26):e16258.
Lee SP, Powers CM. Individuals with diminished hip abductor muscle strength exhibit altered ankle biomechanics and neuromuscular activation during unipedal balance tasks [published correction] in Gait Posture. 2014 May;40(1):278]. Gait Posture. 2014;39(3):933-938.
Lee JH, Jung HW, Jang WY. A prospective study of the muscle strength and reaction time of the quadriceps, hamstring, and gastrocnemius muscles in patients with plantar fasciitis. BMC Musculoskelet Disord. 2020;21(1):722. Published 2020 Nov 5.
McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290.
Miller LE, Latt DL. Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies. N Am J Med Sci. 2015 Jan;7(1):1-5. doi: 10.4103/1947-2714.150080. PMID: 25709971; PMCID: PMC4325390.
Monteagudo, M., et al. (2018). "Plantar fasciopathy: A current concepts review." EFORT open reviews 3(8): 485-493.
Moon D, Jung J. Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial. Healthcare (Basel). 2021;9(10):1358. Published 2021 Oct 13.
Morrissey, D., et al. (2021). "Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values." British journal of sports medicine.
Mucha MD, Caldwell W, Schlueter EL, Walters C, Hassen A. Hip abductor strength and lower extremity running-related injury in distance runners: A systematic review. J Sci Med Sport. 2017;20(4):349-355.
Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med. 2009;19(3):201-206. doi:10.1097/JSM.0b013e3181a38fb1
Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport.2006;9:231-237.
Park SY, Bang HS, Park DJ. Potential for foot dysfunction and plantar fasciitis according to the shape of the foot arch in young adults. J Exerc Rehabil. 2018;14(3):497-502. Published 2018 Jun 30.
Petraglia, F., et al. (2017). "Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review." Muscles, ligaments and tendons journal 7(1): 107.
Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study. Foot Ankle Int. 2002 Jul;23(7):619-24. doi: 10.1177/107110070202300706. PMID: 12146772.
Rathleff, M. S., et al. (2015). “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.” Scandinavian Journal of Medicine & Science in Sports 25(3): e292-e300.
Ribeiro, A. P., et al. (2022). "Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial." BMC Musculoskeletal Disorders 23(1): 1-14.
Ridge S, Bruening D, Jurgensmeier K, et al. A Comparison of Foot Strengthening versus Minimal Footwear Use on Intrinsic Muscle Size and Strength. Foot & Ankle Orthopaedics. July 2018.
Robroy L. Martin, et al. (2014). “Heel Pain—Plantar Fasciitis: Revision 2014.” Journal of Orthopaedic & Sports Physical Therapy 44(11): A1-A33.
Santos BD, Corrêa LA, Teixeira Santos L, Filho NA, Lemos T, Nogueira LA. Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report. J Chiropr Med. 2016;15(4):310-313.
Schuitema, D., et al. (2019). "Effectiveness of mechanical treatment for plantar fasciitis: a systematic review." Journal of sport rehabilitation 29(5): 657-674.
Sweeting D, Parish B, Hooper L, Chester R. The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. J Foot Ankle Res. 2011 Jun 25;4:19. doi: 10.1186/1757-1146-4-19. PMID: 21703003; PMCID: PMC3150253.
Thomas, J. L., Christensen, J. C., Kravitz, S. R., Mendicino, R. W., Schuberth, J. M., Vanore, J. V., ... & Baker, J. (2010). The diagnosis and treatment of heel pain: a clinical practice guideline–revision 2010. The Journal of Foot and Ankle Surgery, 49(3), S1-S19.
Tu, P. (2018). “Heel pain: diagnosis and management.” American family physician 97.

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