Defined

A condition in which the bottom of the heel can be extremely painful.

A heel spur develops as a bony overgrowth on anterior aspect (forward aspect) of the heel bone (calcaneus).  The development of the spur is usually a result of prolonged inflammation of the plantar fascia (a muscle-like ligament) on the bottom of the foot that attaches to the heel bone.  Constant abnormal pulling of this ligament irritates the attachment to the heel bone and the body seeks to hold onto the attachment by forming additional bone growth as a protective mechanism.

Symptoms

The patient presents with a dull to sharp pain occurring about the plantar calcaneal area when getting out of bed of a morning.  The plantar fascia is more inflexible at those times or when arising from a seated position and continuing during the initial periods of weight bearing.  Usually the pain subsides within a few minutes, but may re-occur once this sequence is re-established.

The pain is often described by patients as a "stone bruise".  Pain can be located at the inferior aspect of the heel either medially, laterally or centrally.

Surveys in the USA show that overweight patients and/or those leading a sedentary lifestyle have a much higher incidence of heel pain, in fact recent reports indicate that over 2.5 million new cases are reported each year in the USA.

Biomechanical Aetiology

Heel spur is the result of faulty biomechanics - walking gait abnormalities that place too much stress on the heel bone and the soft tissues attached to it.  Prolonged inflammation of the plantar fascia on the bottom of the foot that attaches to the heel bone results in a spur growing.

Excess subtalar joint pronation lowers the arch structure and as the foot elongates, a traction force is placed on the plantar fascia.  These tractional forces can result, over time, in inflammation of the fascia and surrounding tissues.  Chronic traction of the plantar fascia from the calcaneal tuberosity occurs and causes the development of a bony growth on the calcaneal tuberosity.  The resultant projection or bone growth is called a "spur" - referred to as a "heel spur".  Plantar fasciitis is the forerunner to a heel spur.

Treatment

Biomechanical heel spur is best treated mechanically by neutralising abnormal foot mechanics.  ICB Orthotics are designed to control excess subtalar joint pronation as it will assist the foot structure in maintaining the correct angle of 42° to the sagittal plane, lift the longitudinal arch reducing and releasing plantar fascial tension.

Initially low dye strapping can be used if the patient or practitioner is unsure as to whether alternative treatment will be effective (see strapping link).  Usually almost immediate pain relief is experienced, however major reduction in symptoms will definitely be achieved within 2-3 days.

Surgery to detach the spur from the heel bone has not proved effective and should be avoided whenever possible.  Realignment of the bony structure by orthotic device is non-invasive and good results can be achieved.

An ideal product to use for this condition is the ICB Dual Density* Orthotic which gives flexibility under the heel bone (calcaneus) whilst supporting and controlling the foot through the longitudinal arch and around the heel by using two different densities of EVA - a world first!

*patent pending

 

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