Dear Dr. Steve: What causes a heel spur? What is the best treatment for a heel spur? M.U., Belle River

Dr. Steve: A heel spur is a calcium deposit, which grows into the tendon of the muscle or fascia on the bottom of the foot. The heel or calcaneous bone is the point of insertion for the muscle along the bottom of the foot known as plantaris. It is also the point of insertion for the ligamentous covering of the bottom of the foot known as the plantar fascia. These structures span the length of the foot and connect along the forefoot behind the toes.

A heel spur forms over time and may be very small and dull or protrude far into the tendon and come to a sharp point. This hardening of the tendon causes inflammation around this area. This inflammation of the tendon and surrounding structures may develop into plantar fasciitis. Symptoms may be non-existent or may be characterized by minor pain and discomfort around the heel area. In severe cases, symptoms can include sharp shooting pain in the heel and radiating into the bottom of the foot and even up into the achilles tendon and calf. The pain is usually aggravated by excessive walking. The symptoms are generally worse in the morning with the fist few steps out of bed. Pain may be worse after sitting for a while without weight on the feet due to contraction of the inflamed muscle. Heel spurs may develop in one foot or both feet, or can be symptomatic in one foot but not in the other.

Pes Planis or flat feet can be a contributing factor to heel spurs because they increase the amount of pull on the plantar fascia. Heavier people are also more likely to suffer from heel spurs. These predispositions are amplified by footwear with poor arch support. Spending prolonged periods of time walking on cement floors can also contribute to developing heel spurs or irritating heel spurs.

There are several conservative treatments for heel spurs. Specific stretches and ice should be the initial treatment of choice. Ultrasound is also useful in softening tissues around a heel spur and drawing blood to the area to reduce inflammation. Massage and deep tissue work on the plantar fascia can also decrease inflammation and relive stress on the heel spur. Orthotics should be used for anyone suffering with a heel spur. Orthotics support the arch of the foot which decrease stress on the heel insertion and absorb some of the shock from walking which can irritate a heel spur. A special heel spur pad can also be built into orthotics to decrease direct shock and stress on the heel. Beyond the conservative treatments listed above, surgery may be required for those who suffer from severe symptoms for a prolonged period of time with no results or relief from conservative therapy.

Though symptoms may persist for prolonged periods most will resolve with conservative therapy and orthotics. Your chiropractor should be consulted for a proper diagnosis and treatment plan. Your chiropractor will fit you with a pair of custom fit orthotics and get you back on the road to recovery.