Thursday, September 26, 2013

Heel Spur

Heel pain is a common complaint in my OPD. Patients have lots of misconceptions and needless fear of heel pain. 
As we all know, the bones of the feet form an arch. Only the heel bone and the bones in the front of the foot (metatarsal heads) actually touch the ground while standing or walking. There is a strong fibrous tissue in the sole of the foot extending from the heel bone along the length of the foot. It is called the Plantar Fascia. Plantar Fascia is very tough and takes most of the weight of the body. It acts like a shock absorber. 
Sometimes the fascia gets inflamed especially at the point where it attaches to the heel bone. The condition is called Plantar Fasciitis (Heel Spur). The reason for the inflammation is not clear. It can happen to anybody at any age. It is uncommon in children. This results in heel pain. The pain typically is severe after a period of rest. The first few steps are very painful. As the person continues to walk, the pain decreases. A person with Plantar Fasciitis gets severe pain on taking the first step out of bed in the morning. Then the pain decreases with a few steps. At the end of the day, after walking and standing a lot, the heel becomes painful again. The severe pain (in some patients) and the difficulty in walking generate a lot of anxiety. The inflammation leads to growth of new bone at the area of attachment of the Plantar Fascia. This new bone can be seen on x-ray. It looks like a spur, hence the name - 'Heel Spur'. The name is a misnomer. It is the inflammation of the fascia which is the reason for pain and not the new bone formation. The growth of the bone is a reaction to the inflammation. Therefore surgical removal of the excess bone rarely leads to a decrease in pain!
Thankfully, Plantar Fasciitis is a benign disorder. By that I mean it does not lead to progressive damage of bone or tissue. More often than not the disorder is self limiting. After a period of time which is variable from patient to patient, the Fasciitis resolves by itself. 
There is no cure for this condition. However, as the condition will better itself over time, treatment is directed at reducing pain.  So, how should patients deal with this pain? My first recommendation is to wear soft footwear. One should wear soft slippers at home especially in houses that have a tiled or marble flooring. For outdoors, one should wear comfortable shoes like running shoes. In addition one can use a silicon heel insert in the shoe for added softness and comfort. This simple remedy will decrease pain considerably. Soaking the feet in hot water at the end of the day will also help decrease pain. I also recommend stretching exercises. One effective way to stretch the fascia is to stand on ones toes for 10 to 20 counts. 
In some patients these simple measures do not work. A short course of anti inflammatory medication prescribed by your doctor may help. But taking these medicines for long periods of time has its own problems and is not recommended. For those in severe pain who have no relief with the usual treatment methods, I recommend a local steroid shot (injection). As the steroid is used locally, systemic side effects of steroid medication do not occur. As such, a single steroid injection in the heel is safe. This injection permanently solves the problem for most patients. In a few, the pain recurs after a few months and rarely the injection does not give any relief at all. 
To conclude, Plantar Fasciitis is a disorder that a patient should not worry about. It is not a serious illness. In all probability it will cure itself, given enough time. Simple treatment methods and a few lifestyle modifications will work for most patients. Those in severe pain should opt for the injection as it is safe. Surgery is rarely required and there are no guarantees that it will work. 

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