A heel spur is a bone growth on the bottom or back of the heel. Foot and heel bone spurs are areas where excess bone has grown forming a small lump which sticks out. The result can become inflamed and painful.
The cause of heel spurs can often be traced back to a gradual injury due to repetitive friction or stress or consistent pulling of the attachment of the plantar fascia. This can be due to footwear, exercise, inflammation, biomechanics or simply from aging.
Common examples of this are heel bone spurs either at the back of the heel (often due to Achilles tendonitis or calf muscle tightness), or underneath the heel as a result of plantar fasciitis.
The heel pain on the bottom of the foot is characterized as a sharp biting pain with the first few steps in the morning and in the evening after increased activities with minor relief as it is “warmed up” during light walking and massage.
The level of rest can range from a decrease in activities, to crutches and non weight-bearing on the affected foot for 1-3 weeks. Avoid bare feet and shoes without support (including sandals and flip-flops).
Static stretching in the morning and evening using the proper technique will speed up recovery and minimize the chance of re-injury.
Anti-inflammatory medication, both oral and topical, can assist with easing the discomfort that comes with chronic heel spur pain.
An anesthetic (numbing agent) mixed with cortisone (anti-inflammatory agent) is placed at the point of pain to relieve the sharp pain associated with the first few steps in the morning, and/or the pain at night after a day of increased activities.
Temporary arch supports, supportive athletic shoes, or a higher heel on a shoe will all provide additional rest to the injured ligament. Custom molded orthotics is the best solution for immediate and long-term treatment.
A night splint is a device that keeps a constant tension on the ligament while it is healing by keeping the foot at a 90 degree angle to the lower leg.
Examples of helpful physical therapy activities to decrease pain involved with heel spurs include massage, cold therapy, contrast baths, stretching, ultrasound, and electric stimulation.
Heel spur removal on the bottom of the calcaneus is preceded by a release of the plantar fascia. This first exposes the spur and it is then simply filed down with a special instrument. The incision is minimal (1cm to 1 ½ cm) at the inside of the heel and sutures are removed after 2 weeks.
Heel spur removal at the attachment of the achilles tendon is more complicated. It requires total or partial detachment of the tendon and then removal of the spur. Reattachment can be with or without a bone anchor, non weight-bearing with crutches is for 4 to 8 weeks depending upon the procedure.
The procedure is performed in an outpatient facility under sedation and partial weight-bearing on the ball of the foot is allowed after 48 to 72 hours of non weight-bearing. Full weight bearing and return to shoes at 2-3 weeks after the sutures are removed.
The length of time for heel spur recovery varies by the type and placement of procedure. The plantar heel spur is attached to the plantar fascia, and has a short healing time of 3 to 4 weeks. Posterior heel spur recovery can be up to 3 months due to its attachment and surgical repair of the achilles tendon.
Heel spur surgery pain is minimal. Discomfort will vary in the first 72 hours postoperatively and responds best to rest, elevation, ice, and pain medication if needed. After surgery, weight-bearing on the ball of the foot is permitted, but partial weight-bearing on the heel after suture removal (about 2 weeks) can cause pain for up to 4 to 8 weeks.
A heel spur is, in essence, the attachment of the plantar fascia to the bottom of the heel bone. This variety of plantar fasciitis is more accurately defined as an ‘enthesitis’—an attachment of a ligament or tendon to the bone. A patient can have plantar fasciitis at any portion of this ligament, but the plantar heel spur is only at its attachment.
Plantar heel spur surgery is very successful and is very low risk. Posterior heel spur surgery is also successful, but the risk much higher due to its involvement with the achilles tendon.
Partial weight-bearing on the ball of the foot is permitted after plantar heel spur surgery. Full weight-bearing, or ‘normal walking,’ is permitted after suture removal at 2 to 3 weeks.
Exercise is not the best route of healing for a symptomatic and painful heel spur. Rest, arch supports, and stretching are the best treatment.
Bone spur surgery is done both in a hospital and out-patient facility setting, most commonly under general anesthesia, but local anesthesia with light sedation is also an option. The surgery itself can be performed ‘open’ with sutures to close the incision or utilizing endoscopic equipment that require only steri-strips to close the small incision.
A heel spur will last for life, but the painful symptoms that can be treated conservatively. Moreover, many people have asymptomatic heel spurs that do not have pain as well.
A heel spur will not go away on its own, but the pain can. More importantly, not all heel spurs are painful or have any symptoms.
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Find relief from painful heel spurs by contacting Moore Foot and Ankle Specialists today! We’ll discuss treatment options that will best fit your lifestyle so you can start healing.
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