A heel spur is a projection or growth of bone where certain muscles and soft tissue structures of the foot attach to the bottom of the heel. Most commonly, the plantar fascia, a broad, ligament-like structure extending from the heel bone to the base of the toes becomes inflamed, and symptoms of heel pain begin. As this inflammation continues over a period of time, with or without treatment, a heel spur is likely to form. If heel pain is treated early, conservative therapy is often successful, and surgery is usually avoided.
Early signs of heel pain are usually due to plantar fasciitis, the inflammation of the plantar fascia. It is probably the most common cause of heel pain seen by the podiatrist. It is seen in all groups of people; runners, athletes, weekend warriors, people who have jobs requiring a fair amount of standing, walking, or lifting, and those who have recently gained weight. The pain most often manifests itself after periods of non-weight bearing when the plantar fascia is given a chance to rest, so your first steps cause a sudden strain to the tissue. Pain is most common with the first steps in the morning and after periods of rest. Fortunately, upwards of 80 percent of those treated early do remarkably well with conservative therapy.
Initially, patients receive cortisone injections or a short course of an anti-inflammatory medication, taken orally. Exercises, night splints, and physical therapy are used as methods to try to reduce the inflammation. If successful, a custom in shoe orthotic is made to control the abnormal stress and strain on the plantar fascia resulting in remission of the majority of the symptoms.
In some instances, conservative therapy fails, and surgery is indicated. Many times a plantar fasciotomy is done in which a release of some of the fibers of the plantar fascia is performed through an incision on the side of the heel. Recovery is often 3-4 weeks with a period of non-weight bearing in a slipper cast.
When the plantar fascia undergoes mico-herniations (tears) or is chronically inflamed, a heel spur may develop. Again, if treated early, even patients with spurs find satisfactory remission of symptoms with conservative therapy such as padding, strapping, injections, physical therapy, and in-shoe orthotics. Unfortunately there are those whose symptoms are severe enough to prevent them from performing their job or recreational activities, and surgery is then indicated.
Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well.
Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.
After they are removed, normal weight-bearing is allowed and the patient is treated with in office physical therapy.
Shock Wave Therapy is an alternative treatment for plantar fasciitis before resorting to surgery, which has a lengthy recovery time and carries the risk of complications. The Food and Drug Administration approved a shock wave device for adults who have been under treatment with conservative methods and have experienced no relief. This device is similar to the sound wave treatment that has been used for years to break up kidney stones. During the treatment, shock waves are focused on the point of maximal tenderness on the heel and it is bombarded with high intensity sound waves. Patients seldom feel any pain because the area is anesthetized with local anesthetic. The theory is that the sound waves break up the scar tissue and create acute inflammation to replace the chronic condition which allows normal healing tissue to repair the injury and alleviate the pain. The ultrasound imaging system provides a live picture of the inside of your foot to indicate the exact treatment site and where shock waves are being delivered. The shockwave therapy system produces the actual shock waves, which are delivered outside your body through the therapy head’s water-filled cushion. The therapy head is attached to the end of an arm-like device on the system. This articulated arm moves easily so that the therapy head can be lined up closely to your foot. The Doctors at Northwest Podiatry Center are among the handful of Podiatric Surgeons in Illinois who are trained to perform this innovative procedure. Patients resume normal activity and wear regular shoes the day after the procedure. Shock wave therapy is not for everyone and should not be used on people with bleeding problems, those taking medication that interfere with blood clotting, or for children or pregnant women. The cost is not covered by many of the major insurance companies, but shock wave therapy has been shown effective in many clinical trials and studies. The physicians at Northwest Podiatry Center like the fact that the treatment is low risk and noninvasive. In studies in Europe, where shock wave has been administered for over 10 years, patients with chronic plantar fasciitis rated an 80 percent successful outcome with just one treatment. More recent studies show an even higher success rate. If you have been suffering from heel pain, and would like to know what can be done to correct the problem, or have any further questions, we're here to help you. For more information, or to make an appointment, please contact the physicians of Northwest Podiatry Center, at any of our convenient locations.
Heel pain is an extremely common and potentially disruptive affliction that has many possible causes. These include stress fractures, arthritis, nerve irritation, cysts, tendinitis, and, most often, plantar fasciitis.
Plantar fasciitis occurs when the tissue that connects the heel to the toes becomes inflamed. This inflammation causes pain on the bottom of the heel that can continue to grow in intensity over time.
Risk factors include:
- Flat feet
- High arches
- Nonsupportive shoes
Treating Plantar Fasciitis
There are many conservative treatment options for plantar fasciitis, including a stretching regimen, icing, footwear modifications, anti inflammatory medications and weight reduction to lessen impact on the feet.
More severe cases may be treated with additional padding and orthotic devices, the use of a walking cast, night splints and physical therapy. Surgery to detach the plantar fascia is an option, but only if all other treatments have been ineffective.
If you are experiencing heel pain, schedule an appointment with your trusted podiatrist today. The sooner you get treatment, the sooner you can walk without pain.