Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis

Foot Ankle Int. 2016 Sep;37(9):994-1000. doi: 10.1177/1071100716649925. Epub 2016 May 13.


Background: This study classified plantar heel spurs and their relationship to plantar fasciitis.

Methods: Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis.

Results: The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05).

Conclusion: Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs.

Level of evidence: Level III, comparative series.

Keywords: heel; plantar; plantar fasciitis; spur.

MeSH terms

  • Fasciitis, Plantar / pathology*
  • Fasciitis, Plantar / therapy
  • Heel / pathology*
  • Heel Spur / classification
  • Heel Spur / pathology*
  • Humans
  • Pain Measurement
  • Visual Analog Scale