Heel Spurs and Plantar Fasciitis
A heel spur is a point of excess bone growth on the heel that usually extends forward toward the toes. Heel spurs are visible on x-rays, which is how their existence is confirmed.
The most common heel problems are actually caused by a painful tearing of the plantar fascia connecting the toes and the heel. This can result in either a heel spur or plantar fasciitis.
If your foot flattens or becomes unstable during critical times in the walking or running cycle, the attachment of the plantar fascia to your heel bone may begin to stretch and pull away. This will result in pain and possibly swelling. The pain is especially noticeable when you push off with your toes while walking, since this movement stretches the already inflamed portion of the fascia.
Without treatment, the pain will usually spread around the heel. The pain is usually centered just in front of the heel toward the arch. When the tearing occurs at the bone itself, the bone may attempt to heal itself by producing new bone. This results in the development of a heel spur. Without the spur, the condition is called plantar fasciitis.
The pain of this condition can cause you to try to walk on your toes or alter your running stride and gait, which will cause further damage and may cause a problem to develop in your healthy foot. Gait changes in running can also lead to ankle, knee, hip, or back pain.
Causes of Heel Spurs and Plantar Fasciitis
The most frequent cause of these injuries is excessive pronation. Normally, while walking or during long-distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation.
The mechanical structure of your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major effect on their function and on the development of mechanically caused problems. Having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should be stable as you are walking or running. This hypermobility may cause other bones to shift as well as other mechanically induced problems.
Other factors that can contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration can cause plantar fasciitis.
Treatment of Plantar Fasciitis
As with most running-related injuries, evaluate any changes in your training. A decrease in workout intensity and duration is important. Self-treatment for this condition entails making sure that your shoes offer motion control and that they're not contributing to plantar fasciitis and heel spurs.
Check your running shoes to make sure they are not excessively worn. They should bend only at the ball of the foot, where your toes attach to the foot. This is vital! Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here, and neither should a shoe be designed to do this.
Shoe Pushup Test
Perform the shoe pushup test to check where your shoe ends. Hold the heel of the shoe in one hand and then press up underneath the forefoot (where the ball of the foot would be, forward). The shoe should bend at the ball of the shoe, where the metatarsals would be. Next, press under the part of the shoe where the metatarsal heads would be. The shoe should not bend under moderate pressure in this area.
It is important to be aware of how your foot feels over the course of therapy. If your foot is still uncomfortable without the strapping but was more comfortable while wearing it, that is an indication that the treatment should help. Remember, what took many months or years to develop cannot be eliminated in just a few days.
The treatment plan that seems to work best includes carefully following a program of physical therapy with the application of felt straps to the feet. The physical therapy modalities most frequently used include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and galvanic (a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm, which is a contributing factor to the pain).
This treatment has been found most effective when given twice a week. The felt pads strapped to your feet will compress after a few days and must be reapplied. While wearing them, they should be kept dry, but they can be removed the night before your next appointment.
Following control of the pain and inflammation associated with this injury, you should use an orthotic to stabilize your foot and prevent a recurrence. More than 98 percent of the time, heel spurs and plantar fasciitis can be controlled by this treatment, and surgery can be avoided. The orthotic prevents excess pronation and prevents lengthening of the plantar fascia and continued tearing of the fascia. Usually a slight heel lift and a firm shank in the shoe will also help to reduce the severity of this problem.
