If you have been diagnosed with a Heel Spur then you will mostly have an X-Ray showing it. Heel Spurs rarely cause pain, they are the result of inflammation at the site of the heel spur, most commonly caused by the Plantar Fascia (refer to Plantar Fasciitis Treatment) or the Achilles Tendon, either underneath, or at the back of the heel respectively. You can have a plantar heel spur (under the heel) or a posterior heel spur (at the back of the heel).
It is thought that the formation of the heel spur is due to the pulling and irritation on the heel bone, whereby that bone responds by growing more bone, in the direction of the pull.
Heel Spur Treatment
Heel spur treatment, regardless of location, is designed to stop the inflammation and irritation at the site. Once we know why the tendon or fascia is causing irritation to the site, we can stop the pain. We will not be looking to remove the spur, surgically or otherwise. Don’t be too concerned about the Spur itself, it’s not the problem.
You may also read about plantar fasciitis.
Case Study: Heel Pain June 2012
A 37-year-old lady presents at the clinic complaining of pain in her left heel only of approximately 18 months. She shows X rays of both feet and there are large heel spurs underneath both heels. Her heel pain is there every day, particularly in the mornings when she steps down from her bed. She confirms there is no heel pain in her right foot even though a 1cm heel spur is visible. Once again, this supports theory that the pain comes from something other than the spur.
This patient is slightly overweight and walks daily in ballet flats and on assessment has very tight calf muscles, leading to a limited range of motion in her ankle joints. In addition to feeling heel pain she describes cramping in her calf muscles, particularly at the end of the day.
Heel Pain Assessment
With the patient lying face up on the treatment table, firm pressure is applied to the medial side of the heel and the base of the heel, around the sight of pain, and in the vicinity of the heel spur. There is a positive jump response and the patient reports that the pain produced by the pressure feels the same as the heel pain that she feels daily. Patient is advised that her symptoms are consistent with Plantar Fasciitis, and that her pain is coming from inflammation within the plantar fascia, and that the heel spur is not causing the pain. She has the typical signs and symptoms of plantar fasciitis which is the most common cause of pain beneath the heel.
Bio-Mechanical Assessment for Heel Pain
Bisection lines are drawn on the patient’s feet and legs and she is observed walking and running on a treadmill. Digital data is stored and her video is replayed in slow motion. This patient does not over pronate, her feet stand up straight when she walks (and runs) but she appears to have an early heel lift. Her calf muscles are tight so that they function short and they pull the heel off the ground too early in the gait cycle. It is not uncommon to see tight calf muscles and early heel lift in patients with heel pain, in particular plantar fasciitis.
In a static, weight bearing position and with the patient in a relaxed stance position, measurements are taken of the arch height of both feet. Her readings are remarkable: 29mm on the right foot and 32mm on the left. Patient is advised that her arches are very high and that she needs supports, in order to remove the strain from the plantar fascia, and take pressure off the heel and ball of foot.
Heel Pain Treatment
- Dry needling
- Ice packs
- Firm shoes
- Calf stretching
Dry Needling for Heel Pain
Acupuncture needles are inserted using trigger point therapy along the soleus and gastrocnemius muscles. This assists in “softening” and “loosening” the muscles which in turn helps to lengthen them, and increase range at the ankle joint. The reduction in the pull of these muscles on the heel will assist recovery of the plantar fascia and will reduce the heel pain.
Orthotics for Heel Pain
Using a 3d scanner, digital images are captured of the patient’s feet as she lies face down and her foot held in an optimal position. These images will be used to make prescription orthotics which will support the arch of the foot and reduce strain on the plantar fascia. This will allow the plantar fasciitis to settle and the heel pain will stop. The orthotics will have some padding under the heel to accommodate the heel spur, but the patient understands that the heel spur is not the problem and therefore is not the focus of treatment, but the plantar fascia is.
Ice Packs for Heel Pain
The patient is advised to apply ice packs to the base of the heel every day for approximately 20 to 30 minutes. This is to reduce inflammation in the plantar fascia which will accelerate healing and also reduce the heel pain.
Firm Shoes for Heel Pain
The patient is advised that her current footwear is insufficient and that she must use shoes that are more robust, even if just for a short while until her condition has settled. She is given a list of appropriate shoes that she can shop for.
Calf Stretching for Heel Pain
This lady is shown how to stretch her calf muscles in a very specific manner, to ensure she does not irritate the heel as she stretches her calves. The dry needling that was done will facilitate this stretching process and over time her calf range will improve. This will reduce the pull on the heel and allow the plantar fascia to recover, reducing heel pain. Once again, this lady understands that the heel spur is not the problem here and her treatment programme is designed around reducing strain and inflammation on the plantar fascia, and encouraging healing of the plantar fasciitis.
Written by Karl Lockett