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Heel Spurs Demystified

“It feel like a chooking pain in mih heel!” is the way it is described by some clients. “Gosh, this thing feeling sharp, sharp . . . like somebody stabbing mih heel with a knife!” others would say. The terms heel spur and plantar fasciitis are sometimes mixed up by persons. While these two diagnoses are related, they are not the same. A heel spur is a pointed bony outgrowth of the heel bone (calcaneus) and is associated with plantar fasciitis. Plantar fasciitis, however, refers to the inflammation of the plantar fascia, the tissue that forms the arch of the foot.

Spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendonitis) and cause tenderness and pain in the area. However, they can be under the sole of the feet (plantar area), and can cause inflammation of the plantar fascia, localised tenderness and pain, which may worsen by stepping down on the heel.

They don’t always have symptoms. Some are discovered via X-rays taken for other purposes. About 70 percent of patients with plantar fasciitis have a heel spur that can be seen on an X-ray.

A heel spur . . . why me?

It tends to be more common in clients who are middle-aged, but can occur in just about any age group. The inflammation existing in the plantar fascia is the real cause of pain rather than the spur itself. Generally a diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

The plantar fascia is a thick, connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia.

Heel spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, X-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.

Treatment

The treatment is similar to that for plantar fasciitis, because the problems are related; with the main steps being short-term rest and inflammation control. Here are the overall procedures:

  • Rest – Avoid activities that aggravate the symptoms. For example, take a few days off jogging, or prolonged standing, to rest the painful foot. Just resting usually helps eliminate the most severe pain, and will allow the inflammation to begin to settle down.

  • Apply Ice Packs – Icing will help diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms.

  • Exercises and Stretches – These are designed to relax the tissues that surround the heel bone. Some simple exercises performed in the morning and evening, often help patients feel better quickly.

  • Anti-Inflammatory Medications – Will help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.

  • Orthotics (arch supports) – Are often the key to successful treatment. The supports often permit patients to continue their routine activities without pain.

These treatments alone will cure the pain in most patients. Be forewarned though that the symptoms will not resolve quickly. Most patients find relief within about three months, and over 90 percent within one year.

If the pain does not resolve, an injection of cortisone can decrease the inflammation of plantar fasciitis. However, many physicians do not like to inject cortisone around the heel because potentially serious problems can happen cortisone injections in the heel area. The two problems that cause concern are fat pad atrophy and plantar fascial rupture. Both problems occur in a small percentage of patients, but they can worsen heel pain symptoms.

How can I prevent it from recurring?

To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential. Many people use orthotics (arch supports) to relieve pressure over the tender area. It is also important to continue the stretching and exercises. These simple exercises will help maintain the flexibility of the foot and prevent the pain from returning.

What if the symptoms are not resolved?

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release. This surgery is about 80 percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.

Your feet mirror your general health . . . cherish them!

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