50% of People Who Have Had Plantar Fasciitis in the Past Will Develop a Heel Spur.

How do we get heel spurs?

Heel spurs are typically caused by repetitive trauma (stretching, tearing, straining) to the fascia membrane that surrounds the calcaneus. Individuals who are obese, wear poorly fitted shoes, have a pes planus (flat) foot structure and are involved in athletic activity will be more prone to developing heel spurs (Menz et al., 2008). These deformities and disorders cause the foot to be more susceptible to developing heel spurs, as the heel will be predisposed to a greater amount of pressure applied to the heel. A greater amount of pressure will lead to stretching, micro tearing and straining of the surrounding tissue of the heel. As a form of protection, your body will create a smooth calcium layer over the injured area to reconnect the micro-torn tissue (Tahririan et al., 2012).

What are some signs to look for?

1. Look for large callusing on the medial (inner) sides of the heels and the bottom of your big toe.
2. Look at your arch height; people with flat feet are more likely to develop plantar fasciitis and heel spurs than people with higher arches.
3. When walking barefoot, pay attention to how your heels contact the ground. If the initial contact is loud and you are coming down on the inside of the heel, you may be more susceptible to plantar fasciitis and bone spur development.
4. If it feels like you ankle and foot are aggressively rolling in whenever you take a step, this is called pronation. This in turn will result in torsional affects on the fascia and micro-tearing.

How is it treated?

One of the most successful ways this is treated is through custom-made foot orthotics.

1. With a deep heel cup and increased arch support, the orthoses will aid in controlling pronation (ankle and foot rolling inwards). This in turn will result in less torsion strain within the plantar fascia
2. Another treatment option would be to add an extra puff or heel cushioning to the orthotic device. This will promote more shock absorption in the orthoses and prevent hard impact at the heel.
3. A well-out in the orthotic. This well-out will be in the area of the spur, and essentially create a pocket in which it will sit. This in turn will promote healing by alleviating any pressure that could be applied to it.
4. Some other options include stretching of the plantar fascia and calf muscles, low intensity exercises (doing the alphabet with your toes) to promote blood flow to the injured area and anti-inflammatory medication.
5. Purchasing a new pair of shoes, ensuring that they have a wide heel cup with a lot of cushion to prevent any irritation and impact on the heel and plantar fascia.
6. Night splint (Strassburg sock) to help stretch out the plantar fascia when at rest.

References:

Ball, K.A., Afheldt, M.J. Evolution of foot orthotic: Coherent theory or coherent practice. Journal of Manipulative & Physiological Therapeutics. Vol 25 (2): 116-124. 12 February 2005.
Gheluwe, V.B., Danaberg H.J., Hagman, F., Vanstaen, K. Effects of hallux limitus on plantar foot pressure and foot kinematics during walking. J Am Podiatr Med Assoc. 96 (5):428-36. 6 September 2006.
Menz, H.B., Zammit, G.V., Landorf , K.B., Munteanu, S.E. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression. Journal of Foot and Ankle Research. 65: 1:7. 15 December 2008
Petcu, D., Anca, C. Foot Functioning Paradigms. J. Am. Podiatr. Med. Assoc. 34 (3):112-22. 4 January 2012.
Riddle, D.L., Pulisic, M., Pidcod, P., Johnson, R.E. Risk Factors for Plantar Fasciitis: A Matched Case-Control Study. J Bone Joint Surg Am. 85: 872-877. 8 June 2008.
Roxas M. Plantar fasciitis: Diagnosis and therapeutic considerations. Altern Med Rev. 10:83–93. 23 August 2005.
Tahririan, A.M., Motififard, M., Tahmasebi, N.M., Siavashi, B. Plantar Fasciitis. J Res Med Sci. 17(8): 799–804. 4 August 2012.
Vohra P.K., Giorgini R.J., Sobel E., Japour C.J., Villalba M.A., Rostkowski T. Petchu D., Anca, C. Long-term follow-up of heel spur surgery. J Am Podiatr Med Assoc. 89:81–8. 20 Oct 2012.

This article was written by Daniel Steffens C.Ped (C).

---