FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SHOE INSERTS CAN HEAL "HEEL SPURS" -- BUT IT CAN TAKE A YEAR

Question: I've had pain in my foot for several months that my doctor has diagnosed as a heel spur. I'm barely able to walk first thing in the morning, but it eases up after gently walking for a while. By late afternoon it is killing me again. I asked my doctor about a cortisone shot in the heel, but he said no. Instead he started me on ibuprofen and sent me to physical therapy. It hasn't helped. What causes heel spurs and do you have any recommendation on what I should do to get relief?

Answer: The foot is a complex structure made from 26 bones forming 33 joints. These bone structures are then supported by numerous muscles, ligaments and a tough layer of connective tissue called fascia. Problems with any of these parts or with nerves or blood vessels can cause pain in the heel area. Therefore, the first concern we physicians face in helping a person suffering from foot pain is determining the nature of the malady. I'm sure that your doctor asked you questions about the pain you've experienced. Then he probably poked on the bottom of your foot just in front of the heel bone. When you came down from hanging on the ceiling, he was suspicious of a heel spur! But, I'll bet he ordered an X-ray before conferring that diagnosis upon you.

Each step we take exerts a force on the foot about one and one-half times the body weight. Since the average person takes 10,000 steps each day there is considerable opportunity for an over-use or stress injury to one of the parts of the foot. The arch helps cushion the blows of each step, but the arch itself is often a source of trouble.

The bones of the arch are supported in part by a tough layer of connective tissue running from the balls of the foot to the heel. This tissue is called the plantar (meaning bottom of the foot) fascia. The plantar fascia can be injured from repeated micro traumas. Common causes are frequent, prolonged walking -- particularly with poor fitting shoes or ones that have become worn out -- and increased foot stress from carrying heavy loads. If you're obese, the fascia-damaging heavy load you carry is not an external object but your own body. Regardless of the cause, the area of the fascia usually injured is the point where it attaches to the heel. The body will try to heal this type of injury by building up calcium within the attachment point, thereby, forming a heel spur.

Heel spurs can usually be treated successfully by reducing the demand upon the injured plantar fascia. This involves using a heel cup or cushion that raises the heel within the shoe and simultaneously avoids pressure at the painful point. Shoes with a good arch support are necessary and in some individuals custom molded orthotics may be prescribed. The use of ultrasound, hot packs, exercises and other physical therapy treatments can be helpful. Anti-inflammatory medicines like the ibuprofen you have taken are routinely prescribed, but my experience is that they generally provide only minimal relief.

A cortisone injection into the painful area may give some relief, but this treatment isn't free of risk. Consequently, it isn't the first step in treating this disorder. Using the shoe inserts and other conservative measures, it can take up to a year for heel spur pain to clear up. While this approach is successful for most sufferers, surgery may be recommended for those who don't obtain relief from the conservative treatments. And, as you have probably guessed from its last place position on the list of treatments, surgery isn't a wonderfully successful approach to dealing with this problem either.

I'd suggest that you talk again to your doctor or to a podiatrist or an orthopedic surgeon who only does foot surgery about your treatment options.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.