Heel Spurs and Plantar Fasciitis

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Heel Spur

A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). They are attributed to chronic local inflammation at the insertion of soft tissue tendons or fascia in the area. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot.

Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and pain at the back of the heel made worse while pushing off the ball of the foot.

A heel spur is a growth of bone at the bottom of the heel where muscles and other soft tissue attach. Most commonly the plantar fascia (a broad, ligament-like structure extending from the heel bone to the base of the toes) becomes inflamed and causes pain. If this inflammation becomes chronic, a heel spur can grow. It can be said that heel spurs are often a consequence of chronic Plantar Fasciitis.

Plantar Fasciitis

Plantar fasciitis, which is irritation and swelling of the fibrous tissue on the bottom of the foot, is one of the most common orthopedic complaints relating to the foot. The plantar fascia originates at the calcaneus (heel bone) and fans out toward the toes helping to maintain the arch of the foot. When this inflexible tissue is pulled away from the calcaneus, inflammation and thus pain occurs. The body reacts to this by filling in the space with new bone. A “heel spur” is thus caused. (This spur is a result, not the cause of the problem). A vicious cycle is begun as the condition is now aggravated with each step.

What causes plantar fasciitis?

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:

  • Your feet roll inward too much when you walk (excessive pronation).
  • You have high arches or flat feet.
  • You walk, stand, or run for long periods of time, especially on hard surfaces.
  • You are overweight.
  • You wear shoes that don’t fit well or are worn out.
  • You have tight Achilles tendons or calf muscles.

Incidence/Prevalence

Plantar fasciitis is the most common cause of heel pain, occurring in over 10 percent of the population. It most frequently presents in individuals,typically women, between the ages 40-60 years old and people who weight bear for extended periods of time such as athletes and occupations that require prolonged standing. Improper footwear and abnormal foot biomechanics, particularly over-pronation can all put increased tension placed on the soft tissue in the plantar aspect of the foot, increasing the potential risk of developing plantar fasciitis.

Symptoms of Plantar Fasciitis & Heel Spurs

Most people with plantar fasciitis or heel spurs have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

Early signs of heel pain are usually due to plantar fasciitis, (inflammation of the plantar fascia). The pain is greatest after resuming activity after a period of rest (the plantar fascia shortens). Pain in the bottom of the foot on the first steps of the day is a classic sign of plantar fasciitis.

The symptoms usually begin with a dull intermittent pain on the bottom of the foot close to the heel progressing to sharper, more persistent pain. Symptoms are usually worst with the first few steps in the morning or at the beginning of rigorous activity (sports) and may improve throughout the day. The pain tends to be aggravated by prolonged standing and walking.

Treatments

No single treatment works best for everyone with plantar fasciitis.

But there are many things you can try to help your condition get better:

  • Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
  • To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen or aspirin.
  • Do exercises several times a day, especially when you first get up in the morning.
  • Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole.
  • Get assessed for shoe inserts (orthotics). Use them in both shoes, even if only one foot hurts.
  • Taping – Rigid and K –Tape have both proven to be effective in reducing symptoms and discomfort.
  • Chiropractic and Physio Therapy – Management utilises a hands on approach of manual treatment, which includes soft tissue and myofascial / active releases, joint and spinal mobilisations and manipulations, condition specific musculo-skeletal dry needling and electro-physical modalities. We also routinely utilise ESWT as part of your treatment for heel pain and plantar fasciitis. However, all practitioners at Spinal and Sports Care consider lifestyle and regular exercise an important part of the treatment plan and prevention.

Extracorporeal shock wave therapy (ESWT).

Recently, research has shown that an eccentric exercise program in combination with ESWT has superior results that any other therapy or exercise in isolation.

Eccentric (a muscle contraction with the muscle / tendon lengthening) in nature has been reported in research to be most effective and superior to concentric exercises (muscle contraction with the muscle / tendon shortening) and to stretching.

Spinal and Sports Care proudly boasts that it is one of a handful of sports orientated private practices in Sydney to own and operate a musculoskeletal shockwave therapy device.

Shock wave therapy sends sound waves to the foot/heel. These sound waves create “microtrauma” that promote the body’s natural healing processes. Shockwave therapy has an increasing amount of research to support its effectiveness, and is rapidly becoming the treatment of choice for tendinopathies / tendinosis’.

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