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.
Everyone can be affected by heel spurs, however, certain groups of people have an increased risk. For example, Plantar Fasciitis is a common running injury. People who walk a lot are much more likely to have heel spurs or people who play golf or play tennis. Over-weight people are also more at risk for heel bone spurs as our feet are not designed to carry around extra weight. As a result the ligaments under the foot are placed under constant stress, which inevitably will lead to foot problems.
Most people think that a bone "spur" is sharp and produces pain by pressing on tissue, when in fact, these bony growths are usually smooth and flat. Although they rarely cause pain on their own, bone spurs in the feet can lead to callus formation as tissue builds up to provide added cushion over the area of stress. Over time, wear and tear on joints may cause these spurs to compress neighboring ligaments, tendons or nerves, thus injuring tissue and causing swelling, pain and tearing.
Heel spurs and plantar fasciitis are diagnosed based on the history of pain and tenderness localized to these areas. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).
Non Surgical Treatment
The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. Physical therapists may instruct you to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep. Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.
Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.
You can help prevent heel spur symptoms from returning by wearing the proper shoes. Customized orthotics and insoles can help relieve pressure. It is important to perform your exercises to help keep your foot stretched and relaxed.