A heel spur is a calcium deposit on the underside of the heel bone. Heel spurs are related to plantar fasciitis in that both are caused by irritation and lack of support of the plantar ligaments.
Your plantar ligaments are a band of connective tissue that extend along the bottom of the foot and connect your heel bone to the ball of your foot.
Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and
this places a great deal of pressure and strain on the plantar fascia. There is very little ?give? to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If
the foot is properly aligned this pull causes no problems. However, if the foot is ?pronated?(the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch falls
excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. The same pathology occurs with ?supination? (the
rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible; usually have a high arch, and a short or tight plantar fascia. Thus as
weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel. In both cases, the
abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and possibly swelling. If this process continues, the plantar fascia partially tears away
from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.
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.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel
release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.
Non Surgical Treatment
There are various ways to treat heel spurs. The first is to rest and apply ice to the afflicted area. Shoe inserts and night splints can also treat plantar fasciitis, and in turn, heels spurs. Unless
you have stomach sensitivities, you may want to consider taking over-the-counter anti-inflammatory medication such as naprosyn to lower the swelling. A physical therapist can recommend gentle
exercises and stretches to relax the tissue around the heel bone to relieve the tension. Even with these treatments, a stubborn heel spur may not go away. A physical therapist may decide to inject
cortisone into the area to decrease inflammation, but that can cause other problems such as plantar fascial rupture and fat pad atrophy. Extracorporeal shock wave therapy is also an option, which
uses energy pulses to apply microtrauma around the heel spur. Surgery is also an option but is not suggested unless the heel spur lasts more than a year. To prevent heel spurs from returning, shoe
inserts can relieve the pressure on the plantar fascia. Also continue the recommended stretches and exercises.
When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide relief of pain and restore mobility. The type of procedure used is
based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. Depending on the presence of excess bony build up, the procedure
may or may not include removal of heel spurs. Similar to other surgical interventions, there are various modifications and surgical enhancements regarding surgery of the heel.