Heel spur

Heel pain is one of the most commonly presented and treated foot complaints within Greg Robinson's podiatry practice.
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Calcium deposit on the underside of the heel bone (heel spur) is closely associated with scarring or inflammation of the plantar fascia (plantar fasciitis). Either of the indications or combined, limit patients in their daily activities.

Very commonly, heel pain is produced by a strain of the plantar fascia - a long, thin non-elastic ligament along the bottom of the foot extending from the heel bone, splitting and fanning out to attach to the toes.

If the plantar fascia is overstretching or overused inflammation and “microscopic tearing” to the structure can occur resulting in pain in the heel and/ or arch area of the foot.

When the condition is long-standing, traction at the origin of the ligament (at the heel bone) can produce growth of bone in the direction of pull, this is often seen as a "spur" on x-ray.  
The heel spur can be asymptomatic, the pain arises from the inflammation of the plantar fascia. 

X-rays maybe required ruling out other causes of heel pain.

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Causes
Plantar fasciitis strains resulting in heel spur formation over time can occur due to:

• Over-pronation – which is the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch and puts added tension on the plantar fascia.
• High or low foot arch
• Obesity
• Tight plantar fascia (often caused by tight calf muscles). 
• Excessive flattening of the arch on weight bearing i.e. people with flat feet.
• Tight Achilles tendon which connects the calf muscles to the heel
• Wearing improper shoes with soles that are too soft, do not fit well or offer poor arch support
• Different types of arthritis i.e. osteoarthritis and rheumatoid arthritis.

Symptoms
The major complaint of plantar fasciitis is pain and stiffness in the heel and foot. The pain associated with this condition becomes more intense:

• In the morning when you step out of bed and first steps are taken
• Walking after sitting or standing
• Climbing stairs
• After exercise
• With high impact weight-bearing activities.

Treatment

• Greg will review your medical history and conduct a physical examination of your foot as well as a thorough biomechanical examination. This will include a static and dynamic video and pressure plate gait analysis of how you stand and walk.
• X-ray may be ordered in order to diagnose the presence of a heel spur.

Greg will discuss a custom treatment plan with you.

• Treatment often consists of combination therapy, most importantly is supporting the arch and heel with custom

functional orthotics to keep the ligament from overstretching

In brief, treatment may consist of the following -

• Rest
• ​Ice
• NSAIDs (non-steroidal anti-inflammatory drugs)
• Strengthening, and muscle stretching program.
• Orthotics or supportive shoes may be recommended to reduce the pain while walking or standing
• Shockwave therapy treats both the heel spur problem and plantar fasciitis simultaneously. Acoustic waves are responsible for fast recovery, return to daily routine and long-lasting effects in up to 88% of the patients.
• A steroid injection may be administered into the plantar fascia for reducing pain and inflammation.
• Surgical referral ​​

1 Stan Road, Grayston Drive, Morningside, Sandton. Johannesburg