Someone recently said they were able to avoid getting drafted for the Vietnam war because they had bone spurs. This post is my attempt to learn more about bone spurs. Let me just say that I don’t believe any statements or claims this individual, or others on his behalf have made, because he’s always making crude, insulting and grandiose statements about everyone else or other things. Simply looking at his ostentatious taste proves he has a grandiose style. Click here or here to learn more or read an excerpt below.
There are approximately 75 different causes of heel pain. At least 80% of all heel pain is due to heel spurs. A heel spur contains calcium, but cannot truly be called a calcium deposit. Bone spurs, whether they are on the heel or on any other bone of the body, are true bone — they are true enlargements of the bone and may be sharp and pointed, or round and knobby. Since bone spurs are true bone, they contain calcium just like regular bones, but are not pure calcium deposits.
Bone spurs usually form around joints that have arthritis, in the vertebrae of the spine, and on the heel. When they form on the heel, they may form on the back of the heel but usually form on the bottom of the heel. Of course, this is where all of the body weight comes down with each step. Spurs on the bottom of the heel are usually most painful the first few steps out of bed each morning. The pain may lessen somewhat after walking for a few minutes, but may be intense again after sitting for a half hour or so, such as after lunch. The pain usually gets worse throughout the day as you are up on your feet more. Often the pain feels like a nail being driven through the heel into the ankle and leg.
WHAT CAUSES HEEL SPURS?
The plantar fascia is a big strong ligament on the bottom of the foot, starting at the bottom of the heel bone and running into the ball of the foot. As the arch of the foot becomes weak, it sags slightly with each step and this causes the plantar fascia to tug and pull at the heel bone with each step. Over a period of time, a spur forms where this big strong ligament tugs and pulls at the heel bone. Soon, inflammation (swelling) starts around this spur and the pain becomes almost unbearable. (Sometimes heel spurs may be present without being painful if no inflammation is present).
FIRST, Reduce the acute pain. This is done by a combination of several things; injection of a synthetic relative of cortisone into the heel, a prescription of anti-inflammatory pills to reduce inflammation, physical therapy and a special heel pad. About 50% of the time, these treatments will permanently relieve the pain. In the other 50%, the pain becomes recurrent, and the treatment proceeds to Stage II.
SECOND, Recurrent, painful heel spur is caused by the tug and pull of the plantar fascia ligament on the heel bone with each step. When the pain is recurrent, arch supports are made to prevent sagging of the arch. The arch supports are custom-made according to the size and shape of the feet. This prevents the arch from sagging and the ligament from tugging and pulling on the heel bone. The inflammation and pain eventually go away as the first phase of treatment is continued along with the arch supports, although the spur itself remains.
THIRD, Surgery to remove the spur is possible and is usually done as Day Surgery.
WHEN SHOULD SURGERY BE CONSIDERED ?
Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain.
- If the pain goes away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered.
- If the pain really never goes away, but reaches a plateau, beyond which it does not improve despite conservative treatments, surgery should be considered.
- If the pain requires three or more injections of “cortisone” into the heel within a twelve month period, surgery should be considered.
WHAT IS THE SURGERY LIKE ?
The operation is done as Day Surgery while you are completely asleep. The incision is placed on the inside of the heel to avoid a permanent scar on the bottom. A surgical drain is placed into the heel to remove any excessive bleeding, and will be removed two days after surgery. Stitches will remain in place for two weeks. Appropriate sterile dressings are used and walking is permitted beginning on the day of surgery in a special surgical shoe, although the amount of walking is limited.
The sharp, severe pain is relieved almost immediately after surgery. The operation is usually not very painful, and most people take one pain pill the first day, and one or two the second day, and then switch to plain Tylenol or Advil thereafter.
Most people are able to return to wearing regular shoes within one to two weeks after surgery, but will experience soreness in the heel as they walk. This soreness subsides week by week, and by six weeks, most people have less pain than before the spur was removed. It generally takes a full 8 months before the soreness is totally gone.
There will be some numbness on the bottom surface of the heel, but this is preferable to the pain associated with a heel spur. You will notice the numbness when you rub or scratch your heel, but it will not affect the way you walk.
On some occasions, heel spurs may return, but this is the exception rather than the rule. We highly recommend continuing to wear custom made arch supports after the operation to help prevent recurrence of the spur.