Heel Spurs and Plantar Fasciitis

WHAT IS THE PROBLEM?

If you were to look at a side view of the bones of your foot, you would see that they form an arch or a bow. Just as in a bow and arrow, the bow of our foot also has a "string" called the Plantar Fascia. This fascia functions as a "shock absorber" by stretching slightly when we walk.

The plantar fascia does have a certain amount of elasticity which allows it to stretch when necessary, but it also must have a limit to that elasticity in order to maintain the arch of the foot. If this were not the case; when we put weight on our foot, it would collapse. When we stretch the fascia beyond its limit, one of two things occur: In mild cases, there will be "micro tears" in the fibers of the fascia which then causes the symptoms of fasciitis. These symptoms include pain and burning in the arch of the foot generally growing more intense as the day goes on. When the stretch of the fascia is increased beyond that point, it generally tears away from its attachment to the heel bone. The heel bone as with all of the bones of our body is covered with a very tough membrane called the periosteum. The fascia attaches to the periosteum which then attaches to the bone. When the fascia tears away from the bone, the symptoms change. Now the pain is more intense with the first few steps in the morning or after sitting for a prolonged period of time. This occurs because the periosteum begins to re attach to the bone when there is no pull on the fascia. When we stand up, we then tear this membrane away from the bone again. The problem is that when this occurs over and over again there is what is called a periosteal reaction at the site of the tear and a heel spur develops. When this occurs, the pain changes once again and is now severe most of the time due to the irritation of the spur.

WHAT CAN BE DONE?

Because this has become such a common problem, treatment methods have improved dramatically. Generally treatment is conservative initially. Anti-inflammatory medication is administered and the foot is taped in a supportive taping for several weeks. During this period of time, you can wear regular shoes and pretty much resume your normal activities. As your symptoms begin to subside, a biomechanical evaluation will be done to determine if orthotics would be helpful. This is almost always the case.

If the spur is too large and conservative treatment does not give relief, surgical intervention may be necessary. At the FORD CENTER FOR FOOT SURGERY, we have developed a procedure that we have used for over 10 years with hundreds of cases. In our surgical area, we have a "mini C arm" which allows us to see inside of your foot on a TV screen. We are able to make a small puncture incision on the bottom of the heel and then use very small instruments to remove the spur. This is done with a regional anesthetic and sedation. The incision is closed with a single stitch. The foot is again taped and the patient is allowed to wear a comfortable shoe.

We encourage you not to delay treatment for this condition as the longer you wait the harder it is to resolve the problem.