Heel Pain & Spurs
Heel Pain Causes
One of the most common and insidious foot complaints that foot specialists see is that of pain on the bottom (plantar aspect) of the heel. There are many potential causes, but the most frequently diagnosed is the one commonly believed to be caused by a heel spur. This origin of heel pain is a biomechanical and functional abnormality.
Much of what is written on this subject internet-wide and discussed in popular lore is as off-base as the medieval theory of leech use.
Let’s start with the misconception that a bone spur is the cause of the pain on the bottom of your heel. Heel spurs are an incidental radiographic finding. They cannot and do not “stick” you. There are people with plantar heel spurs an inch long that have no pain and those without spurring that have severe pain. They need not be addressed surgically, and we would be skeptical of any surgeon that would suggest a plantar heel spur be removed. Plantar heel spurs are the result of the bone’s covering (periosteum) being micro-torn from it by the broad, weak link of the plantar fascia (aponeurosis) attachment to the heel bone (calcaneus). This tearing results in bleeding, inflammation and swelling locally. Over time, the periosteum heals itself by laying in new bone from where it was torn. This results in the presence of the spur noted on X-ray. The pain comes from the torn soft tissues and is typically worse when returning to weight-bearing after a period of rest.
Studies suggest that as many as 30 percent of plantar heel pain sufferers go on to surgery. At Central Florida Foot and Ankle Specialists, PA, less than 0.5 percent of heel pain sufferers require invasive treatment, and 98 percent achieve full resolution of symptoms conservatively. Why such a difference? Conservative treatment success lies in the effectiveness of the modalities utilized to improve the patient’s specific biomechanical abnormalities and imbalance. These imbalances of the feet are often inherited characteristics for which a person has been successfully compensating most of their life. When the compensating foot’s threshold of efficiency in absorbing shock and propelling a body forward is exceeded by the addition of weight, hard surfaces to walk on, time on their feet and several other factors, then a tearing of the tissue on the bottom of the heel results.