Does your heel hurt when you take the first step out of bed in the morning?
Does it take a few minutes of walking around to "stretch out" the bottom of your foot so you can walk with out pain?
Are your friends telling you that you have a "Heel Spur?
Well they may be half right! But to really understand heel pain and how to treat it, we have to dig a little deeper and look at the REAL cause of the pain. Only then can you take the appropriate steps to treat heel pain and regain your life.
Rarely does the actual bony spur on the heel cause any symptoms. In fact one study suggests that 25% of the population, if xrayed, are walking around with a spur on the foot. More often, the actual heel pain is caused by Plantar Fasciitis. The plantar fascia is a type of ligamentous connective tissue just under the skin and fat (subcutaneous tissue) on the bottom of the foot. It provides pretection and support to the muscles and bones in the "arch" of the foot. It courses from the heel bone (calcaneous) to the toes and is important to the function of walking correctly.
When this plantar fascia is damaged, either by stepping on a rock or uneven ground, or overused- by working long hours on hard floors, or suddenly stretched, it becomes inflamed and is very painful. It is this pain and inflammation of the plantar fascia pulling away from its attachment to the heel bone that people feel. As a result of the inflammation your body will lay down bony calcifications to the area. This is the spur, and it forms only after the injury. In fact, when a surgeon addresses the problem, most leave the spur alone, and only release the ligamentous attachment (but this can be avoided 99% of the time-see below)
As you can see in this picture, the spur is not poking "down". It looks like a "spur" only because xrays are 2 dimensional . In 3-dimensions, it is in fact a bony ledge across the foot from one side to another and is where the tendons, muscles,and other structures attach. When the foot is overstretched or overworked, the tissue pulls away from the bony attachment causing microtears and inflammation. This inflammation under the foot is what is painful.
This changes the goal of our treatment from"removing the spur" to instead
- Using an antiinflammatory to reduce the inflammation-thus the pain
- Supporting the arch of the foot with orthotics or arch supports to eliminates the strain
- teaching the patient how to identify and treat heel pain more quickly in the future
That is why unless trauma or a tumor or true fracture is suspected, xrays do little to identify and treat plantar fasciitis. The "spur" may also be found on the back of the heel. Again, it may have been there for years, but just got aggravated by shoes or activity. So again, don't just toward surgery to remove the bony spur on the back of the heel, treat the inflammation instead. Your podiatrist can help you figure out what caused it, and help you eliminate that and prevent this from recurring.
5 most common treatments for heel pain:
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