In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of
pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an x-ray shows a hook of bone protruding from the bottom of the
foot at the point where the plantar fascia is attached to the heel bone.
A heel spur usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not
provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but
sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.
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.
A Heel Spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone. The plantar fascia is the
thick, connective tissue that runs from the calcaneus (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. In other words, tremendous stress is placed on the plantar fascia.
Non Surgical Treatment
Initially, treatment usually consists of a combination of ice therapy, stretching exercises to improve flexibility (especially in the mornings), anti-inflammatory medications, and physical therapy.
Most patients will also need custom-molded orthotics to help control the motion in the foot and arch, which takes the strain off the plantar fascia. If the pain continues, a cortisone injection may
be used to calm the severe swelling and pain. There may the need for a night splint to maintain a stretch in the plantar fascia throughout the night.
Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar
fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the
surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery
with typically smaller incisions on each side of your foot.
Prevention of heel spur syndrome may be best by finding a good supportive shoe. Never go barefoot or wear a flat soled shoe. There are many over the counter arch supports that give increased support
for your feet. Usually when there is excessive pronation the Achilles Tendon contracts or becomes shortened over time since it is not being used fully. The shortened Achilles Tendon is called an
equinus deformity. By keeping this tendon stretched it may decrease some of the tension in the foot. Some theories believe the Achilles Tendon and plantar fascia is continuous. Before you get up from
rest, stretch out your Achilles and the plantar fascia. You may attempt to spell the alphabet with your foot and ankle, use a towel against pressure on your foot, or roll a can of soup or sodapop on
the ground. Ice may work well at the times of severe pain. For a chronic pain, or longer lasting pain heat therapy may improve the condition.