Background & Etiology
There are 28 bones in the foot, and over 30 joints. The bones in the foot include the phalanges, the metatarsals, three cuneiform bones, the cuboid bone and the navicular bone, which make up the arch of the foot, the talus bone and the calcaneus (heel bone). A common cause of heel pain is a condition called a heel spur, where an abnormal hook of bone grows on the calcaneus.
The calcaneus is the largest bone in the foot. Pain in the heel region can sometimes be related to Plantar Fasciitis, inflammation of the plantar fascia ligament in the heel area. A heel spur is a hook of bone that forms on the calcaneus where the plantar fascia attaches. Heel spurs can be identified with an X-ray. A heel spur can occur with or without Plantar Fasciitis.
Heel Spur typically occurs in people who have a history of foot pain, and is most often seen in middle-aged men and women. The bony growth itself is not what causes the pain associated with heel spur. The pain is typically caused by inflammation and irritation of the surrounding tissues. Approximately 50% of patients with a heel spur also experience Plantar Fasciitis.
- Sudden, sharp pain in the bottom of the foot
- Tenderness in the heel of the foot
- A hook of bone on the calcaneus that is visible upon X-ray examination
- Pain with prolonged standing and walking similar to plantar fasciitis
- Discomfort with weight bearing and initially getting up from sit to stand.
The first line of treatment for Heel Spur is to avoid the activities and positions that cause the pain. A physician can evaluate your foot with an X-ray to diagnose Heel Spur and determine a course of treatment.
This condition can often be treated by non-surgical means; however in severe cases surgery may be necessary to relieve the pain. The most common surgical procedures treat the soft tissues around the Heel Spur, often a tarsal tunnel release or a plantar fascia release. Injections for heel spurs are sometimes controversial as steroids may cause heel pad atrophy or damage the plantar fascia.
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Heel Spur include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the foot and ligaments.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the foot and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running, jumping, kicking, or stepping) in daily use of the involved lower extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the foot and ligaments.
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy may include:
- REST and ICE
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- NSAIDS (Non-steroidal Anti Inflammatory Drugs)
- Stretching program designed by a physical therapist.
- Steroid shots or injections into the heel
- Surgery to correct underlying pathology
- Orthotic devices or special shoes
- Night splints to stretch the injured tissue and allow it to heal
Most people recover full function following a course of conservative care that includes physical therapy, and pain relief. It is important that once the pain is reduced, and motion and strength are restored, the patient gradually returns to full activities. Non-surgical methods are typically effective and reduce the pain associated with this condition. Treatment can take several months until symptoms improve. A regiment of stretching and the use of appropriate footwear is crucial to long term success with this condition.