A Bony Growth on the Heel

The plantar fascia is a band of fibrous tissue that is attached to the heel bone (calcaneus). This tissue runs along the bottom of the foot and attaches to the metatarsal bones at the ball of the foot. When subjected to repeated trauma, such as running, or from a sports injury, the plantar fascia can become inflamed at the point it attaches to the heel bone. The resulting inflammation can lead to a condition known as plantar fasciitis. Plantar fasciitis in turn can cause a spur—a small bony projection on the underside of the heel—to form. Plantar fasciitis can cause significant heel pain, making walking and running difficult. Heel spurs typically do not cause pain until the surrounding tissue becomes inflamed, so that an individual may have a spur without knowing it. The treatment for plantar fasciitis includes placing ice on the area to decrease swelling, adding heel inserts to shoes, splinting the area at night, stretching exercises for the calf and heel, use of oral nonsteroidal anti-inflammatory drugs and cortisone injections into the area to relieve pain, and, rarely, surgery to expand the fascia.

Inflammation of fibrous tissue where it connects to the heel bone is the cause of most of the pain that occurs in heel spurs, not the spur itself.

Avoid Excess Trauma to Feet

A band of fibrous tissue (plantar fascia) runs along the bottom of the foot and forms an arch. This band of tissue is connected to the heel bone (calcaneus) on one end and the metatarsal bones located at the ball of the foot. The tissue can become inflamed when it is repeatedly stretched at the point where it is attached to the heel bone, resulting in a condition known as plantar fasciitis. Plantar fasciitis (sometimes called painful heel syndrome) can cause mild pain in the heel area only when weight is placed on it; in its more serious form, it can cause intense, constant throbbing pain. For most sufferers, the pain is most intense upon arising in the morning, or after sitting, standing or walking for long periods. Plantar fasciitis can lead to the formation of a heel spur, a small bony growth.

Typical Causes: Plantar fasciitis can be caused by a variety of factors, including excessive running or running on hills or sandy surfaces. The condition can also occur in people who have flat feet or highly arched feet, or in persons who wear shoes without good arch supports. It was once thought that heel spurs were the cause of pain in plantar fasciitis; actually, the heel spur itself probably does not cause pain. The tissue inflammation is the cause of the heel pain in these patients. In fact, many patients experiencing pain as a symptom may not show a clear image of a heel spur after an x-ray is taken, although the spur may develop later. As the heel spur grows larger, the heel pain may actually improve as the foot adapts to the changes. This is why surgery to remove a heel spur is not routinely performed in many patients.

Diagnosis: The diagnosis of plantar fasciitis is usually made by examination of the heel and determining what sort of pressure is causing the pain. Typically, plantar fasciitis itself does not cause heel swelling or warmth. Other conditions that can induce heel pain, such as rheumatoid arthritis, gout, ankylosing spondylitis, stress fractures, or nerve compression injuries, can be ruled put as causes by examination and x-ray.

Treatment: Most sufferers of heel pain due to calcaneal spur syndrome find relief from avoiding activities that caused the inflammation in the first place, such as switching from running or engaging in other weight-bearing exercises to swimming or hiking. Placing a foam pad, heel cup or orthotic insert in the shoe may be helpful. The use of a nonsteroidal anti-inflammatory drug, available without a prescription, is often recommended for inflammation and pain. Corticosteroid injections can help to control inflammation. Proper stretching of the heel and calf prior to activity, and using an ice pack on the area after the activity, can also help relieve pain. For some patients, wrapping the area to avoid nighttime movement is effective. Relief from pain and healing of inflammation may take several weeks to several months. If none of the treatments is effective, further tests may be done to see if there are other injuries to the heel. As stated, surgery to remove spurs is rarely necessary since the spur is typically not the cause of heel pain, but in some patients, surgery to relieve the tightness of the inflamed plantar fascia at the heel may be performed. After surgery, the foot is kept immobile for several weeks, followed by several weeks of physical therapy to help healing and increase the mobility of the foot.