The difference? None actually. The terms are synonymous. Let me explain.
More than 75 years ago, when x-rays were a new tool, a group of patients with plantar heel pain presented to their doctor who took an x-ray of the heel. In a number of cases, patients with plantar heel pain showed evidence of a spur on the bottom of the heel. Therefore, the name heel spur seem appropriate.
But about thirty years ago, we started to look a bit closer at the problem of plantar heel pain and found some troubling questions. Why do some people with a heel spur on x-ray have no history of heel pain? And why do some people that have no heel spur seem to have the exact symptoms of heel spur patients? What we came to realize is that what we once knew as a heel spur is not really a bone problem after all. It is a soft tissue problem.
Soft tissue you say? Exactly. The primary reason for plantar heel pain is not a bone problem but is actually due to the pulling of the plantar fascia on the bottom of the heel. This tugging and pulling of the plantar fascia causes what we call today, plantar fasciitis.
What once was called a heel spur or heel spur syndrome, is now called plantar fasciitis. And this transition from old terminology to new terminology is very important in understanding the etiology and treatment of plantar heel pain. If we think of this condition as a heel spur, our treatment plan ends up going down a dirt road in that the focus is on ways to accommodate the spur; horse shoe pad, soft cushion, etc. And these methods of care rarely address the primary cause of plantar fasciitis.
So what causes plantar fasciitis? Ironically it’s due to the calf through a relationship we call CT band syndrome. Check out those links for a good run down on how we acquire plantar fasciitis and how it’s treated.
Jeffrey Oster, DPM