Heel Spurs
Definition of Heel Spurs
The heel bone is the largest bone in the foot and absorbs the most amount of shock and
pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits
form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or
heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along
the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can
cause extreme pain in the rearfoot, especially while standing or walking..
Causes of Heel Spurs
The most frequent cause is an abnormal motion of the foot called excessive pronation.
Normally, while walking or during long distance running, your foot will strike the ground
on the heel, then roll forward toward your toes and inward to the arch. Your arch should
only dip slightly during this motion. If it lowers too much, you have what is known as
excessive pronation. For more details on pronation, please see the section on biomechanics
and gait.
The mechanical structure of your feet and the manner in which the different segments of
your feet are linked together and joined with your legs has a major impact on their
function and on the development of mechanically caused problems. Merely having "flat
feet" won't take the spring out of your step, but having badly functioning feet with
poor bone alignment will adversely affect the muscles, ligaments, and tendons and can
create a variety of aches and pains. Excess pronation can cause the arch of your foot to
stretch excessively with each step. It can also cause too much motion in segments of the
foot that should be stable as you are walking or running. This "hypermobility"
may cause other bones to shift and cause other mechanically induced problems.
Other factors which may contribute to plantar fasciitis and heel spurs include a sudden
increase in daily activities, increase in weight (not usually a problem with runners), or
a change of shoes. Dramatic increase in training intensity or duration may cause plantar
fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before
the toe joints will cause an increase in tension in the plantar fascia. Make sure your
shoes are not excessively worn. These shoes and other shoes that are not sufficiently
controlling of pronation combined with an increase in training can lead to this condition.
A change in running style, such as starting speed work, running on the ball of your foot
or sudden increase in hill workouts.
Diagnosisof Heel Spurs
A thorough medical history and physical exam by a physician is always necessary for the
proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are
helpful, as excess bone production will be visible.
Treatmentof Heel Spurs
Heel spurs and plantar fascitis are usually controlled with conservative treatment.
Early intervention includes stretching the calf muscles while avoiding re-injuring the
plantar fascia. Decreasing or changing activities, losing excess weight, and improving the
proper fitting of shoes are all important measures to decrease this common source of foot
pain. Modification of footwear includes shoes with a raised heel and better arch support.
Shoe orthotics recommended by a healthcare professional are often very helpful in
conjunction with exercises to increase strength of the foot muscles and arch. The orthotic
prevents excess pronation and lengthening of the plantar fascia and continued tearing of
this structure. To aid in this reduction of inflammation, applying ice for 10-15 minutes
after activities and use of anti-inflammatory medication can be helpful. Physical therapy
can be beneficial with the use of heat modalities, such as ultrasound that creates a deep
heat and reduces inflammation. If the pain caused by inflammation is constant, keeping the
foot raised above the heart and/or compressed by wrapping with an ace bandage will help.
Corticosteroid injections are also frequently used to reduce pain and inflammation.
Taping can help speed the healing process by protecting the fascia from reinjury,
especially during stretching and walking.
When chronic heel pain fails to respond to conservative treatment, surgical treatment
may be necessary. Heel surgery can provide relief of pain and restore mobility. The type
of procedure used is based on examination and usually consists of releasing the excessive
tightness of the plantar fascia, called a plantar fascia release. Depending on the
presence of excess bony build up, the procedure may or may not include removal of heel
spurs. Similar to other surgical interventions, there are various modifications and
surgical enhancements regarding surgery of the heel.
Alternative treatmentof Heel Spurs
Acupuncture and accupressure have been used to address the pain of heel spurs, in
addition to using friction massage to help break up scar tissue and delay onset of bony
formations.
Prognosisof Heel Spurs
Usually, heel spurs are curable with conservative treatment. If not, heel spurs are
curable with surgery. About 10% of those that continue to see a physician for plantar
fascitis have it for more than a year. If there is limited success after approximately one
year of conservative treatment, patients are often advised to have surgery.
Preventionof Heel Spurs
To prevent this condition, wearing shoes with proper arches and support is very
important. Proper stretching is always a necessity, especially when there is an increase
in activities or a change in running technique. It is not recommended to attempt working
through the pain, as this can change a mild case of heel spurs and plantar fascitis into a
long lasting and painful episode of this condition. |
