She came to the Clinic limping in pain and almost at her wits end; quite disillusioned in fact. She had been diagnosed with heel spurs, and had brought the X-rays to prove it, but the various treatments were not effective… she was still in pain after a year.
As well, from doing the consultation, it was realised that she had Plantar Fasciitis too. But she had not been given that diagnosis. This situation is not isolated, instead it is becoming quite common.
What is a Heel Spur?
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.
Spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendonitis), and can 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. But about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur. In other words, though the two conditions are related, they are not the same.
Who is at Risk?
Patients who have a history of foot pain caused by plantar fasciitis commonly have spurs. In the setting of plantar fasciitis, they are most often seen in middle-aged men and women, but can actually be found in all age groups.
The plantar fascia is the 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.
Because the two problems are related, the main considerations should be short-term rest and inflammation control. The following are the overall procedures:
-Decrease your training temporarily. 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.
-Do gentle stretching of the calf muscles: Wall stretches – 10 seconds each side. Repeat ten times. Do two sets of 10 reps each day.
-Check shoes for flexion stability. Avoid and replace any shoe that bends before the ball of the foot. Put your flip flops in the closet and forget about them for a very long time.
-Try wearing shoes that offer more anti-pronation control
-Perform 20 seconds of “toe curls” three times daily to strengthen your intrinsic foot muscles.
-Ice 15 minutes, with a 10 minute break, repeat 1 – 2 times each day.
-Consider rolling your foot over frozen water bottle ( or using frozen peas rather than ice).
-Examine your training regimen carefully, if you’ve been keeping a running diary – check it for possible training errors.
-Do not go barefoot in your house. Also, no slippers, flip flops, open back shoes, sandals that are open in the back without attaching your heel to them.
-Get tested for orthotics (arch supports), which are often the key to successful treatment. The supports often permit patients to continue their routine activities without pain.
-Use of anti-inflammatory medications could help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.
The majority of patients will get pain relief from above these measures; most within approximately three months, while over 90 percent within one year.
If the pain does not resolve, an injection of cortisone can sometimes decrease the inflammation of plantar fasciitis. However, be forewarned that potentially serious problems can happen using 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.
Is Surgery an Option?
Usually less than 5 percent of patients may not experience relief from the conservative treatments, which should be attempted 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.
Can it be Prevented from Recurring?
To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential. Many people use the orthotics 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.
Your feet mirror your general health . . . cherish them!