A 37-year-old female runner presents to the clinic complaining of pain from a heel spur. She reports to the podiatrist that she recently completed the city to surf annual run and that not long after she began to feel severe pain in the base of her left heel. During the build-up to the run she increased her level of activity from three days per week to five days per week. During this build-up to the race the patient did report that she felt some mild pain in the base of her heel, and this was possibly coming from a heel spur. This patient has no medical illnesses and does not suffer from diabetes or any other significant medical condition. She takes no medication and has never experienced foot problems in the past aside from the occasional ankle sprain.
As is typical with patients who have pain from a heel spur, this patient reports a considerable amount of pain first thing in the morning when she puts her foot to the floor. She also feels significant pain after being seated for long periods at work when she walks away from her chair.
Approximately 2 hours after completing the city to surf this patient reports that the pain from her heel spur was intense and she was unable to walk without limping severely. She decided to sit down in a local cafe and her friend retrieved an ice pack from the local chemist which she applied for the next 60 Minutes. The pain from the heel spur reduced significantly following the application of the ice pack and she was able to walk back to the bus stop without limping too much. However, the next morning, the pain was intense and she was unable to walk without holding on to the wall or the furniture. In order to reduce the pain from the heel spur the patient decided to strap her foot with rigid sports tape and wear her trainers to the office. Once in the office, and seated, she felt more comfortable and the pain from the heel spur reduced. However, she decided to take some medication to reduce the inflammation and to reduce the pain. A friend of the patient suggested that she may have a heel spur as she herself had suffered the same symptoms some time ago. Taking this information into account she decided to seek the help of a podiatrist who may be able to assist. The podiatrist advised the patient that more often than not the pain associated with this condition is not a direct result of a heel spur, but moreover a condition known as plantar fasciitis.
The sports podiatrist applied firm pressure to the base of the heel in the area where the heel spur usually develops. Upon applying this pressure, the patient reported extreme pain and retracted her foot. She reported to the podiatrist that this pain felt the same as the pain she experienced during walking and running. The podiatrist advised that she had a condition known as plantar fasciitis and that this was the cause of her heel pain, not the heel spur.
This particular patient was concerned about the presence of a heel spur and requested that the podiatrist refer her for an x-ray. This request was met and the films came back clear. The report confirmed there was no heel spur present. Once again, it is a common misconception that the heel spur is the cause of pain in such situations. The most common cause of discomfort is due to plantar fasciitis.
In order to determine the cause of this patient’s heel spur symptoms, the podiatrist carried out a thorough physical assessment including a footwear check. The running shoes that this patient was using were a minimal shoe that offered very little support. The shoes were lightweight and flexible and had worn badly. The patient was advised that the level of support that she had been receiving from these shoes was insufficient and that this would have led to significant stress and strain on the muscles and tendons of both feet and lower legs. The lack of support and the negative impact on the foot would have led to strain on the plantar fascia causing it to pull on the heel and lead to plantar fasciitis.
Rigid sports tape was applied to the patient’s affected foot in order to give support and reduce the strain on the plantar fascia. This tape would stay in place for approximately 5 days and would be changed regularly by the patient or the podiatrist. The patient was advised that the tape would be used for approximately 3 to 4 weeks until her condition had resolved completely. Following a detailed foot assessment, the podiatrist was able to recommend specific running shoes for the patient. The patient was advised to purchase the shoes as soon as possible in order to support the foot and reduce the inflammation around the base of the heel. The podiatrist made it quite clear to the patient that the shoes were not designed to cushion a heel spur but rather support the plantar fascia. She was advised to apply ice packs to the base of the heel every day for approximately 20 minutes before bed. The patient was advised that people with heel spur symptoms recover much quicker if they avoid bare feet and thongs.
This patient returned to the clinic after 8 weeks for a check-up with the sports podiatrist. She had been compliant with sports tape and the use of ice packs. She no longer experienced pain first thing in the morning or after being seated. However, she did report mild pain in her heel if she was on her feet for extended periods of time. She was advised to apply the sports tape in situations where she would be standing or walking for extended periods. Furthermore, she was reminded to use the new running shoes in the same situations. The podiatrist applied pressure to the base of the heel in the area where heel spurs sometimes develop, and this did not elicit any pain. The patient was advised that her plantar fasciitis had cleared and had recovered completely.
Please be mindful that the information contained in this case study is specific to one person and should not be taken as general advice. If you suffer with foot pain or if you think you have a heel spur you should consult with a qualified podiatrist.
Written by Karl Lockett