A common cause of heel pain is the heel spur, which is a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an
inch. When there is no indication of bone enlargement, the condition is sometimes referred to as ?heel spur syndrome.?
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the
lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity. Heel spurs
specifically relate to the bony spurs (extra bony growth) that form at the base of the heel. It is a ?spike? of bone that grows from the base of the heel.
The plantar fascia is a big strong ligament on the bottom of the foot, starting at the bottom of the heel bone and running into the ball of the foot. As the arch of the foot becomes weak, it sags
slightly with each step and this causes the plantar fascia to tug and pull at the heel bone with each step. Over a period of time, a spur forms where this big strong ligament tugs and pulls at the
heel bone. Soon, inflammation (swelling) starts around this spur and the pain becomes almost unbearable. (Sometimes heel spurs may be present without being painful if no inflammation is
Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the
afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present
and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
Heel spurs can be treated by wearing orthotic insoles inside the shoe. Orthotics are designed to correct incorrect gait, in particular over-pronation (rolling in of the foot and collapsing of the
arches). Over-pronation is a very common foot condition, affecting at least half of the population. It is a major contributing cause of heel spurs. Orthotics are very effective in that the device
corrects the foot to its natural position. By supporting the arches properly and preventing excess rolling in of the foot, the plantar fascia is placed under much less strain and stress compared to
an unsupported foot. Less strain on the ligament means less pulling away from the heel bone, allowing the inflammation to heal faster. In addition to orthotic treatment, most podiatrists and
physiotherapists recommend a series of exercises to help make the ligaments in the feet and legs longer and more flexible. In turn this will help reduce strain on the plantar fascia.
More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to
relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's
important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for
patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the
area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.