Heel Spurs and Plantar Fasciitis

A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half- inch. Without visible X-ray evidence, the condition is sometimes known as "heel spur syndrome."

Although heel spurs are often painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot.

Treatments for heel spurs and associated conditions include exercise, custom- made orthotics, anti-inflammatory medications, and cortisone injections. If conservative treatments fail, surgery may be necessary.

Causes of Heel Spurs

Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.

Risk factors for heel spurs include:

• Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel
• Running or jogging, especially on hard surfaces
• Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
• Excess weight and obesity

Other risk factors associated with plantar fasciitis include:

• Increasing age, which decreases plantar fascia flexibility and thins the heel's protective fat pad
• Diabetes
• Spending most of the day on one's feet
• Frequent short bursts of physical activity
• Having either flat feet or high arches

Symptoms of Heel Spurs

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain -- especially while walking, jogging, or running -- if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.

Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning -- a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Non-Surgical Treatments for Heel Spurs

The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking.

If you have heel pain that persists for more than one month, consult a health care provider. They may recommend conservative treatments such as:

• Stretching exercises
• Shoe recommendations
• Taping or strapping to rest stressed muscles and tendons
• Shoe inserts or orthotic devices
• Physical therapy
• Night splints

Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.

Surgery for Heel Spurs

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.

Prevention of Heel Spurs

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities.

Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.

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