Heel Spurs

Considered a repetitive stress condition in which your fascia experiences wear and tear at the weakest point, where it attaches to your heel bone. Every time your foot strikes the ground your plantar fascia is stretched. Forces in your foot strike can reach 2-3 times your body weight depending on if you are standing, walking, running or jumping.

This extra tension can result in overstretching, inflammation and/or micro-tearing of the fascia at your heel which your body finds difficult to repair. As your body tries to heal itself, a heel spur or osteophyte (bony outgrowth or calcium deposit) develops around the bottom and/or the back of your heel (associated with achilles tendonitis), which protrudes into the soft tissue. It can vary in shape from a flat, shelf-like growth to a hook-shaped, pointy projection, and can extend forward up to a half inch. Your body hopes this extra bone and tissue will help to relieve the pressure on your plantar fascia. Heel spurs can affect your ability to do your usual work and/or activities, and can also trap and irritate the nerves in your heel area. They can change the way you walk, and can lead to knee, hip and low back injuries. If severe, they may require medical intervention.

Heel spurs affect 10-21% of the population, and are most frequently seen in athletes, people who are on their feet all day, are overweight and/or over 40 years of age.

Many people refer to plantar fasciitis and heel spurs as one in the same. Although these are similar, they are not same. Heel spurs can actually be caused by plantar fasciitis; 50% of people with plantar fasciitis have heel spurs, whereas 19% of people have heel spurs without plantar fasciitis.

Alternate names and/or associated conditions:

Pump bump, exostosis, calcaneal spur syndrome, heel spur syndrome, Haglund's deformity

Causes

Your plantar fascia is only able to stretch to 102% of its length without tearing; therefore it doesn't have much flexibility when exposed to excessive weight or heel pounding. The main cause of this condition is from overuse and overloading in occupations where you are on your feet all day (teachers, store clerks, soldiers, waitresses, hostesses), activities that require you to push heavy items (shippers and receivers, construction workers) and/or sporting activities in which you overexert yourself (doing too much, too fast and/or too soon), especially running, football, baseball, basketball, tennis, volleyball, step-aerobics, stair climbing, dancing.

Poor biomechanics (abnormal twisting of your foot) affects the way your foot hits the ground. If you overpronate (feet rolling inward) you tend to have a low arch and flat foot (pes planus), which increases pressure on your plantar fascia. If you underpronate (feet rolling outward) you tend to have rigid feet and a high arch (pes cavus), which results in a shortened plantar fascia.

Faulty foot structures (abnormal growths, different leg lengths, and unhealed injuries) and muscle imbalances (tight, weak or shortened muscles in your foot, ankle, calf and hamstring) can cause you to walk on your toes which increases the strain on your plantar fascia and the muscles on the sole of your foot (flexor digitorum brevis and quadratus plantae).

Regular shoes or high heels that are too tight or don't support your heel or arch affect the distribution of your body weight on your foot and add undue stress to your plantar fascia and back of your heel. This causes a lot of rubbing and pressure points on your foot.

Health conditions such as obesity, inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis), bursitis, neuroma (nerve growths), gout, diabetes, Haglund's deformity, and achilles tendinitis can also instigate the problem.

Symptoms

You may or may not experience any symptoms with your heel spurs. It is normally the inflammation felt in the tissues around your heel spur that cause discomfort.

Heel pain is one of the first things you may notice, especially when pushing off the ball of your foot (stretches the plantar fascia). This can get worse over time and tends to be stronger in the morning, subsiding throughout the day; although it does return with increased activity.

A sharp, poking pain in your heel that feels like you're stepping on a stone can often be felt while standing or walking. You will sometimes be able to feel a bump on the bottom of your heel, and occasionally bruising may appear.

Diagnosing

Your doctor will take your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray (check for arthritis, bone spurs and joint inflammation) or blood tests (rule out diseases or infections) may be requested.

Treatment and Prevention

Heel spurs are considered a self-limited condition, which means that by making small alterations in your lifestyle and regular routines you can often control the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive foot areas. Failure to see improvements after conservative treatments may make surgery your only option.

Rest and activity modification are among the most important things you can do to help recover from your heel spurs. Ice and compression will help to ease your pain and discomfort from inflammation. A compression brace is the best option to receive this type of treatment.

Ultrasound is an excellent tool to reduce pain and inflammation. The application of ultrasound over the affected foot area reduces swelling, increases blood flow, decreases pain, relieves tension making muscles and tendons more flexible, minimizes scar tissue, and helps tissues heal more quickly. It can be performed at home easily and safely with a portable ultrasound device.

Other conservative treatments:

Properly sized comfortable footwear (leave a 1/2 inch space between longest toe and inside of shoe) with significant arch support and motion control. Also, avoid running around barefoot, or on hard and uneven ground.

Corrective footwear, orthotics (insoles and arch supports) or other foot devices (walking casts, night splints) provide support and alignment.

Cushioning or supportive items, such as taping or donut-shaped heel cushions protect, reposition your foot, and relieve pressure pain.

Exercises that stretch and strengthen your foot (flexor digitorum brevis and quadratus plantae), ankle (achilles tendon) and leg muscles (soleus, gastrocnemius, hamstring) keep you balanced and flexible.

Gentle foot massage helps relax tissues; physio therapy, chiropractic care, reflexology and acupressure are effective in relieving tension, strengthening your foot and helping with alignment.

A balanced diet keeps your weight maintained.

Extracorporeal shockwave therapy, corticosteroid or Botox injections have been used, but must be administered by a medical professional and involve some risks. Steroid injections have been known to weaken the tissues and cause ruptures.

Pain and anti-inflammatory medications can help relieve some aches and pains.

Heel or plantar fasciitis surgery (endoscopic plantar fasciotomy, open heel-spur fasciotomy) helps to relieve pressure, reduce pain and remove the calcium spur from the heel area. However, surgery is not a guarantee and there can be complications. If the plantar fascia is not repaired when the heel spur is removed, it is likely it will return.

Recovery from heel spurs can take between 6 weeks - 18 months, depending on the severity of your condition and your commitment to proper rehabilitation. The more dedicated you are with your treatments, the faster you will see successful, long-lasting results.

See AidMyPlantar.com for more detailed information on Plantar Fasciities.