Heel Pain & Spurs

Heel pain is widely considered the most common foot disease. With 59,000,000 Americans experiencing heel pain each year and 55% suffering from this condition at some point in their lifetime. The heel bone is designed to be the first contact the foot has with the ground. With each strike, during the forces of walking, the heel bone is subjected to the pulling of attached ligaments of the plantar fascia and the tendons of the Achilles. Both of which result in inflammation and subsequent pain. Walking adds up to 1.5 times your bodyweight on your feet and the average person logs approximately 1,000 miles per year.

The greatest incidence of heel pain is seen in middle aged men and women. Those who participate in regular exercise and sporting activities, are obese, on their feet a lot or wear improper footwear or high heels also may experience an increase in occurrence. Heel pain is also common amongst children, typically between ages 8 and 13, as they become increasingly more active in both life and sports. As shock absorbers, feet cushion up to 1,000,000 pounds of pressure during 1 hour of strenuous exercise.

Mechanical factors, however, are the most common etiology of heel pain. Individuals with high arches, flat fleet, or feet that role inward or pigeon are at greater risk of contracting heel pain. These foot abnormalities place added stress on the heel bone and the soft tissues attached to it. Outside forces resulting from injury or a bruise incurred while walking, running or jumping, especially on hard surfaces can also contribute to heel pain. A neuroma, soft tissue growths, an inflamed bursitis and bone enlargement at the back of the heel are additional indicators of heel pain.

Symptoms of heel pain consist of redness, swelling, inflammation and tenderness. Limiting normal activity is the first measure of defense and treatment for an occurrence of heel pain.

Early treatment should include rest and NSAIDs. If allergic to NSAIDs, consider an all natural herbal blended topical analgesic to mitigate your pain and inflammation. Cold therapy or ice, taping, strapping supports and non-invasive medical appliances like a foot brace will help stressed muscles and prevent straining and overuse of your plantar fascia. Maintain a static or fixed position for both your plantar fascia and Achilles tendon during normal daily movement, like walking, will decrease pain and speed your recovery significantly. Additional physical therapies may be used to increase resolution and decrease recovery time.

A heel spur is one indicator commonly associated with heel pain. A spur or calcification is a clump of minerals or bony growth under the heel bone. These bony protrusions grow on the posterior and bottom surfaces of the heel bone and develop over a long period of time. Spurs usually develop in conjunction with chronic plantar fasciitis and or Achilles tendonitis. There is no visible features on the heel, but instead a deep painful spot that is found in or around the midsole of the heel. Heel spurs result from significant strain on the muscles of the foot and develop as a result of the foot working in an abnormal way. This may be from a biomechanical imbalance, a condition that occurs in many people.

Heel spurs, also referred to as traction spurs, grow in the same direction that the tendons pull away from the heel bone. This is why they can occur on the bottom of the heel or plantar fascia and on the back of the heel, or Achilles tendon. Some people may only develop 1 type of heel spur, but both problems are closely related so it's not unusual for individuals to develop both types of heel spurs.

Often the fascia ligament which attaches to your heel and stretches forward extending to your toes is overworked. When this happens, and it happens with every step, the insertion point, where the facia connects to the heel becomes inflamed and inherently painful. The bone in the heel then attempts to compensate by forming a growth of additional bone, trying to stop the pulling that occurs as you move. The end result is a bony growth which is referred to as a heel spur. 28,300,000 Americans suffer from heel spurs annually and approximately 10% of the U.S. population may suffer from heel spurs without any indications of pain.

Most heel spurs, however, are typically not the cause of heel pain. If you have been experiencing heel pain for only a few weeks and this is your first occurrence, it is unlikely that a spur is present. Having heel pain is not a clear indicator of a heel spur. 

Unlike heel pain, conservative treatment methods may not be enough to resolve your pain. An initial diagnosis of heel spurs by your doctor will include X-rays to determine the scope of the problem.

Once a calcification has occurred the body is unable to break apart the mineral mass. Conservative treatment options like cold therapy or ice, topical analgesics, insoles and foot braces will only moderate your condition and temporarily displace your pain. If your pain is not severe and is not inhibiting normal movement, daily activity or your exercise regimen then an adjustment in your daily routine in conjunction with conservative methods should keep your pain and discomfort from increasing and accelerating. If, however, your pain is significant then more aggressive treatment and or surgery will be required.

One of the most effective treatment alternatives for heel spurs is radial shockwave therapy. This non-invasive medical procedure uses an electromagnetic pulse to break apart the formation of minerals. Widely considered ultrasound on steroids, radial shockwave therapy is a quick and easy in-office procedure that can be readily performed by an orthopedic or podiatric specialist. Treatment protocols vary from case to case, but on average expect to receive between 3 and 7 treatments before the spur has been broken up and your body begins to dissolve it completely. If radial shockwave therapy is an unavailable treatment option then surgical intervention may be required.