Welcome to the Heel Spur Clinic!

With over 25 years of foot health experience, and biomechanical research, we can guarantee relief from heel spur pain in over 80% of cases. Before going into detail about our treatment methods, let's first have a look at the symptoms and causes of heel spurs and heel pain. It's important to understand that heel spurs are often misdiagnosed and the actual cause of pain and discomfort during walking is not the spur itself, but a more common condition called Plantar Fasciitis.

Plantar Fasciitis is the most common foot condition in the UK with thousands of sufferers in all age groups, but in particular the over 50’s. It is latin for inflammation of the plantar fascia and it is the main cause for the formation of calcaneal spurs, or heel spurs and pain in the heel area. Plantar Fasciitis is a weight bearing functional gait problem and can only be treated accordingly ie. by correcting poor gait pattern. Patients are usually referred for X-Ray scans to determine calcaneal spur growth and inflammation in the heel area. In some cases spur development is clearly visible, however it paramount to understand the spur itself is not the problem, but rather a mere symptom of Plantar Fasciitis A typical clinical sign associated with Plantar Fasciitis is soreness to palpation of the medial calcaneal tuberosity and the medial aspect of the proximal longitudinal arch. Fat-pad degeneration under the heel is common in elderly patients, causing tenderness and contributing to heel pain. In most cases, Plantar Fasciitis has to be attributed to poor foot biomechanics. A poor gait is quite common and is caused by a factors like excess pronation at the Subtalar Joint, tightness of the calf muscles, short and tightened plantar fascia and achilles tendons. In addition weakened foot and ankle muscles and also weight gain can play a role.

As a result of faulty foot biomechanics the longitudinal arch height is decreased, forcing the plantar fascia to lengthen on weight-bearing. This increased tensile stress is imposed on the medial calcaneal tuberosity where the plantar fascia attach to the heel bone. Repetitive excess stress on the plantar fascia then leads to inflammation of the plantar aponeurosis and micro-tearing of the ligament. Over a period of time a calceneal spur may develop. Calceneal spurs however a far less common that general heel pain. More often Plantar Fasciitis will cause pain under the heel or at the back of the heel. Some people may experience arch pain as a result of stress on the plantar fascia. The calcaneus (or heel bone) is the largest bone in the foot, and when walking the heel touches the ground first and therefore always a constant pressure is exerted on the heel. This is why heel pain is a condition most seen by podiatrists and other foot specialists, compared to other medical complaints.

Heel Pain explained

Besides the formation of a calcaneal spur, pain in the heel area is a typical symptom of Plantar Fasciitis. Heel pain is one of the most common types of foot pain in adults and very often becoming appearent after increased daily activities such as work, exercise, walking long distances, walking up steps or stairs etc. A person may have had a spur or plantar fascia problems for a long time, but only until they increase their activities or gain weight the condition will result in pain or discomfort. Pain may occur at the bottom of the heel, but also at the back of the heel, a condition called Achilles Tendonitis. Other heel conditions include Bursitis and in children Severe’s Disease.

First let’s look at the anatomy of the heel. Two structures at the underside (the sole) of the foot are relevant in particular to heel pain: the plantar fascia or plantar aponeurosis in the sole of the foot and the flexor muscle (the Flexor digiti minimi brevis), together they form the arch of the foot. During walking and running the foot absorbs the weight of the body when the foot lands. The foot and ankle have a locking mechanism which raises the arch preparing the foot for the propulsive phase of gait. The plantar fascia stabilises the arch and provides stability of the 1st MP joint and medial arch through the windlass mechanism. This mechanism brings about plantar flexion of metatarsals, which elevates and stabilises the longitudinal arch, inverts the calcaneus and externally rotates the tibia (bones in the lower leg). The plantar fascia supports the arch of the foot by acting as a tie-rod, where it becomes tensed when weight is placed on the foot. The plantar fascia continuously elongates during the contact phase of gait.

What causes heel pain? (more...)

Plantar Fasciitis Treatment

There are many different treatment options available nowadays for Plantar Fasciitis. Some better than others. Some are short-term, other methods provide long-term heel pain relief. Usually a combination of treatment options provides the most effective relief. Patients usually have x-ray scans taken of the heel area, which may show some spur growth at the calcaneus. Heel spurs are actually not causing any pain, but are rather stimulated by pain i.e. the problem of Plantar Fasciitis. The following treatment options are recommended:

1) Rest: to completely rest your feet, means no walking or standing whatsoever, which is practically impossible for anybody! Basically one should cease any sports, walking distances, playing golf etc for a number of weeks. Also try and avoid standing for periods of more than 10-20 minutes. This will give the ligaments a chance to recover, or at least will stop the condition from worsening. Most importantly avoid any walking or standing barefoot on hard floors and tiles, as this will surely aggravate Plantar Fasciitis. Also avoid walking up-hill.

2) Anti-inflammatories: A short-term treatment for Plantar Fasciitis, but it will generally help most patients to get through their day. Painkillers like Ibuprofen reduce inflammation and therefore pain, but they do not address the root cause of the problem, which is the excessive tension placed on the Plantar fascia. (more...)

Heel Pain in New Zealand

Many people in New Zealand suffer from heel pain, also referred to as heel spurs. There is pain in the anterior part of the heel or the heel bone. The symptoms are often the most intense whilst standing but they will diminish during the day. However, after a day of activities (sports, standing for a while, walking distances etc), the pain at the end of the day will increase. Sometimes the pain may radiate to the rest of the foot or the inside of the leg. In most cases the pain is caused by inflammation of the plantar fascia which runs from the heel to the toes under the foot. The inflammation is caused by overloading of the tendons where they insert into the underside of the heel bone. This overload can be the result of a combination of the following factors: ill-fitting shoes and not enough shock-absorption, especially in sports like running, aerobics and long walks, standing for a while etc. Also misalignments of the foot (flat foot, fallen arches, over-pronation). Or fast weight gain in a relatively short time (e.g. through pregnancy) and last but not least age plays an important role with New Zealanders and sore heels.

The inflammation can lead to calcium build-up being deposited onto the heel bone (or calcaneus). In that case we speak of a "bone spur". Ossification of the posterior calcaneal spur occurs in the calcaneal attachment of the Achilles tendon. This form is also known as Haglund's syndrome. While one can present with inflammation and thickening of plantar fascia, only in an ultrasound image becomes the heel spur visible on radiographs. A bone spur is not painful and requires no treatment. It's just a symptom of heel pain and Plantar Fasciitis Treatment of heel pain and heel spurs. The pain is annoying but fortunately usually disappears over time, whether or not spontaneous. In approximately 50 percent of patients the pain disappears within 3 to 4 months. If pain is still present after 4 months treatment is required. If the pain is very annoying and persistent, you'll need to consult your doctor. The doctor will ask you a number of questions (about your symptoms, your daily activities and your shoes) and will closely examine your feet, palpating the heel area. If necessary, the assistance of a physiotherapist, chiropodist or an orthopaedic shoemaker may be required. As an emergency action you may be given medication like an anti-inflammatory providing an instant pain relieving effect. What can you do yourself? To fight pain in the heels you can try the following:

1) seek advice from a professional (physiotherapist, chiropodist, podiatrist, orthopaedic shoemaker, sports medicine advisory center on your shoes. 2) the application of ice-compressions on the painful area (ten minutes twice daily) 3) reduce the load on the foot by taking regular rest.4) If overweight try to lose some weight. 5) for elderly persons: muscle strengthening exercises for the feet (under the guidance of a physiotherapist) A heel spur is found in about 10 percent of the population. It occurs most frequently between the ages of 40 and 60 years of age, but often remains asymptomatic. In the great majority of those affected, the symptoms remain without any specific treatment or conservative treatment (without operations) is employed. The various forms of treatment available include orthotic insoles which have a recess in the area of the spur for pressure relief. This recess has typically a foam cushion. In addition, it must be supported with in the longitudinal arch, because the padding of the spur itself is not enough usually. Also, physiotherapists often prescribe targeted exercises for Plantar Fasciitis to reduce stress and tension.

Different types of Heel Pain and Spurs

Heel pain is very common in Germany, but there are a number of different forms of heel pain, including Plantar Fasciitis, Heel Spur Syndrome, Sever's Disease, Bursitis, Dry Cracked heels and also pain at the back of the heels, a condition called Achilles Tendonitis. By far the most common problem is Plantar Fasciitis. This is the inflammation of the plantar fascia - a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation, swelling, soreness and heel pain. Plantar fasciitis can be caused by various factors such as inadequate or inappropriate footwear, sudden weight gain, or a particular exercise or activity. Also a poor gait pattern (i.e. the way you walk) can play a role with this condition. It is normal for heel pain to affect only one foot at a time. Chronic heel pain often leads to the formation of a build-up of bone (this is a called a "spur") at the point where the plantar fascia connects to the heel bone. This is why some medical people refer to plantar fasciitis as heel spur syndrome. Another term used is Policeman's Heel, because of the hard boots and hard surfaces police often walk on.

Anatomy of the foot:

The plantar fascia ligament branches out from the heel bone like a fan, connecting the heel to the base of the toes. When the foot moves during walking the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in comparable to the string of a bow maintaining the the bow's arch. The most notable and obvious symptom of plantar fasciitis is pain under the heel. Most severe in the middle of the heel and in some cases it can radiate along the sole of the foot. The pain is most severe when walking first thing in the morning or after a period of rest. As walking continues the pain may diminish. However some degree of pain remains present on movement, but the pain turns into a dull ache. Heel spur or Fersensporn may disappear when resting for a while, when the plantar fascia is more relaxed. Plantar fasciitis is caused by the repetitive over-stretching of the plantar fascia. If the tension on the plantar fascia is too much this over-stretching causes micro tears in the tissue. This in turn causes the plantar fascia to become inflamed and painful and leads to heel pain and spurs. (more...)

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