REVIEWS OF DR. SCHULER
Heel Spurs explained by Dr. Burton S. Schuler,
WHAT IS A HEEL SPUR? The heel bone is the largest bone in the foot and absorbs the most stress. A heel spur is an abnormal growth of bone either at the back of the heel, or most commonly on the bottom of the heel. The most common symptom of a heel spur is to have pain when first getting out of bed in the morning, or after resting for 20 minutes then getting up.
WHY DO WE GET HEEL SPURS OR HEEL SPUR SYNDROME? The most common reasons for heel spurs and heel pain is due to excessive stress and stains applied to the heel bone and the soft tissues structures that attach to the heel bone when we walk. This abnormal stress and strain is caused by Abnormal Pronation, which is the result of having a Morton’s Toe Our modern-day society, where many jobs demand long hours of standing on hard concrete, that are unforgiving on our feet also contributes to heel problems. Over a period of years one of the major structures attached to the heel called the plantar fascia (this is the large rubber band structures that hold up your arch, and that goes from the heel to the ball of the foot) pulls away from the calcaneus (heel bone) and causes microscopic bleeding to occur. This bleeding can lead to new bone formation at the heel which eventfully leads to the formation of a bone spur. “Heel Spur Syndrome” is pain of the heel when the plantar fascia is just pulling abnormally at the heel without a spur being formed.
Heel Bursitis, Besides the heel itself being affected, there is a fluid containing sac covering the heel called a bursa. The bursa acts as a shock absorber for the tremendous forces that goes through the heel. This bursa will get abnormally swollen and inflamed when the heel is injured as noted above, resulting in a Bursitis. The medical term for this is a Calcaneal Bursitis and is the cause of the pain upon getting out of bed in the morning or pain upon raising after resting, either at the heel spur on the bottom and or back of the heel bone.
Plantar Fasciitis is a condition where the plantar fascia gets swollen and inflamed, again due to abnormal pronation. Normally it hurts upon standing but normally goes away walking awhile. Surgery is very rare, and conservative treatment is the same as heel spur (see below)
Other causes of heel pain include: physical injury, obesity, poor shoes, muscle inflammation, gout, nerve problem (Tarsal Tunnel Syndrome,) strain of the plantar arch,arthritis or simply excessive walking or standing.
I am of the firm belief that heel spurs lay dormant for years like volcanos. One of the most amazing thing about heel spurs is that at this very moment there are millions of people walking around the world who have massive heel spurs who are not having one drop of pain, and have no idea in the world that they have heel spurs. Many people go thru their entire life with heel spurs who don’t have any heel pain. It is not unusual for me to see a patient who complains of heel pain of about 2-3 months, to have a spur on x-ray that from its size, had to have been there for 20 years. Again I believe something will trigger the heel pain out of the blue when a large spur has been there for many years.
Self-treatment in the early stages of heel pain may include stretching exercises, elevation of the heel, using over the counter anti-inflammatory medications, ice or heat (I prefer heat), losing weight, padding the heel with a soft foam rubber material, or wearing shoes with a thick rubber heel which act as a shock absorber.
If the condition does not respond to such treatment, it is time to consult a podiatrist who will compile a careful medical history and perform a detailed examination of the foot. X-rays are normally needed to assist in determining the nature of the problem. At the Ambulatory Foot Clinic we also employ Thermography in all of our exams for heel pain This allows us to see inside your foot and see your pain. There are only a handful of foot specialist in the Southeast who have this state of the art ability in their offices.
Children can also have severe heel problems. Between the ages of 9 and 13 they can experience pain on the side of the heel caused by an irritation to the growth plate, and is called Calcaneal Apophysitis, or Sever’s Disease. This condition can become serious and should be immediately evaluated by a podiatrist.
Heel spurs and heel pain is the most common problems seen at the Ambulatory Foot Clinic-Podiatric Pain Management Center. Our treatments for these complex problems are not to give painful injections or perform surgeries immediately, but instead use the time proven, highly successful, relatively pain free treatments such as stress free Physical Therapy, medications and removal of the abnormal stress and strain on the heel (which were and are the real cause of the problem) with padding and strapping and then Orthotics to control the underlying Abnormal Pronation which many times is due to Morton’s Toe. There are many highly successful non-surgical treatments for heel spurs and related conditions that give long term relief by treating the abnormal bone pressure. Foot surgery for heel pain is rare and should always be a last resort, but if needed, it is done using minimal incision techniques, in the comfort and privacy of our Clinic.