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HEEL BONE SPUR INTRODUCTION
The most common cause of heel pain is plantar fascitis which is commonly referred to as a Heel Bone Spur. Plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes Click here to view diagram . Plantar fascitis is a condition in which the plantar fascia is inflamed. This condition can be very painful and cause considerable amount of suffering .
Long standing inflammation causes the deposition of calcium at the point where the plantar fascia inserts into the heel. This results in the appearance of a sharp thorn like heel spur on x-ray. The heel spur is a-symtomatic (not painful), the pain arises from the inflammation of the plantar fascia. Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel .
Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing & thin soled shoes.
CAUSES OF HEEL BONE SPUR
- Excessive load on the foot from obesity is a major cause of plantar fascitis. Which is why this condition is common in middle aged and over weight adults.
- A sudden increase in weight, such as pregnancy can also lead to plantar fascitis.
- A sudden increase in walking or a sporting activity can also be a contributing factor. A classical example is a post man who has returned to work after a period away from the job can develop this condition.
- Tight plantar fascia (this is often caused by tight calf muscles) .
- Excessive flattening of the arch on weight bearing.
- Biomechanical problems (walking abnormalities) is a major cause of plantar fascitis .
- Different types of arthritis can also lead to this condition such as osteoarthritus and rheumatoid arthritis.
What is a heel spur?
Patients and doctors often confuse the terms heel spur and plantar fasciitis . While these two diagnoses are somewhat related, they are certainly not the same thing. Plantar fasciitis refers to the inflammation of the plantar fascia--the tissue that forms the arch of the foot. A heel spur is a hook of bone that can form on the foot bone (calcaneus) and is associated with plantar fasciitis.
About 70% of patients with plantar fasciitis have a heel spur that can be seen on X-Ray. However, many patients without symptoms of pain can have a heel spur. The exact relation ship between plantar fasciitis and heel spurs is not known for sure. For more information about plantar fasciitis:
Who gets heel spurs?
Heel spurs are commonly seen in patients who have a history of foot pain caused by plantar fasciitis.
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. The diagnosis of a heel spur 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.
Why did I get a heel spur?
The plantar fascia is a thick ligamentous connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the plantar fascia is tremendous.
When a patient has plantar fasciitis, the plantar fascia becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities can make normal activities quite painful. Symptoms are typically worsened early in the morning after sleep. At that time, the plantar fascia is tight and simple movements stretch the contracted plantar fascia. As you begin to loosen the tendon, the pain usually subsides, but often returns with prolonged standing or walking.
Heel spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70% of patients with plantar fasciitis have a heel spur, x-rays also show about 50% of patients with no symptoms also have a heel spur.
Treatment of heel spurs
What is the treatment of a heel spur?
Treatment of heel spurs is the same as treatment of plantar fasciitis. Because these problems are related, the treatment is the same. The first step in the treatment of a heel spur is with short-term rest and controlling the inflammation. Here are the steps patients should take in order to cure their plantar fasciitis and heel spurs:
- Rest
Avoiding the precipitating activity; for example, take a few day off jogging or prolonged standing/walking. Just resting usually helps to eliminate the most severe pain, and will allow the inflammation to begin to cool down.
- Apply Ice Packs
Icing will help to diminish some of the symptoms and control the heel pain.
- Exercises and Stretches
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly.
- Anti-Inflammatory Medications
Anti-inflammatory medications help to both control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.
- Shoe Inserts
Shoe inserts are often the key to successful treatment of plantar fasciitis. The shoe inserts often permit patients to continue their routine activities without pain.
- Night Splints
Night splints are worn to keep the heel stretched out when you sleep. By doing so, the arch of the foot does not become contracted at night, and is hopefully not as painful in the morning.
These modalities alone will cure the plantar fasciitis pain in most patients. Be forewarned that the symptoms will not resolve quickly. Most patients find relief within about three months, and over 90% within one year.
If the pain does not resolve, an injection of cortisone can decrease the inflammation of plantar fasciitis. However, many physicians do not like to inject cortisone because there are potentially serious problems with cortisone injections in the heel area. The two problems that cause concern are fat pad atrophy and plantar fascial rupture. Both of these problems occur in a very small percentage of patients, but they can cause a worsening of heel pain symptoms.
A new treatment for heel spurs chronic plantar fasciitis is being investigated. This treatment, called extracorporeal shock wave therapy , or ESWT, uses energy pulses to induce microtrauma to the tissue around the heel spur. This microtrauma is thought to induce a tissue repair process by the body. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options. For more information on shock wave therapy treatment:
- Extracorporeal Shock Wave Therapy
After successful treatment, how can I prevent heel spur pain from coming back?
To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential. Many people use shoe inserts to relieve pressure over the tender area. Custom orthotics can also be made if there appears to be a problem with the mechanical structure of the foot. It is also important to continue the stretching and exercises . These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning.
What if the symptoms of the heel spur do not resolve?
In a small number of cases (usually less than 5%), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery . Time is very important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications of the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release. For more information about plantar fascia release:
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 80% successful in relieving pain in the small group of patients who do not improve with conservative treatments.
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