Heel Spurs and Heel Pain

Although this has been discussed in some form before, I feel that it is important to discuss the common misunderstanding of what actually causes heel pain, and where a spur actually fits into the discussion.

To clarify, I am discussing heel pain that is felt on the BOTTOM of the heel and arch, which is by far the most common location for heel pain.  Pain on the BACK of the heel has its own cause, which actually does involve a spur.  However, for the sake of clarity, I will concentrate on pain under the heel.

The most common cause and reason for heel pain is injury to a rubbery, tight band of tissue called the plantar fascia.  Essentially a ligament, this band of tissue begins at the heel bone and runs to the ball of the foot.  It can be directly injured by stepping on something, but for the most part it is injured because one has an arch that is some degree too low or too high.  The more common lower arch is usually the culprit.  One does not have to have a completely flat foot for this to occur, rather just simply feet that collapse a little too excessively from 'normal'.  As this collapse occurs with every step, over the years the fascia tissue will weaken and become damaged close to where the tissue is attached to the heel bone.  Eventually, microscopic tearing and inflammation follow, as does pain.

As the fascia gradually tugs on and away from the heel bone, a reaction begins to form in the outer layer of the bone.  Along this line of traction a calcification process will begin, with the slow deposit of bone following this line to form a spur, somewhat like the gradual formation of a stalactite in a cave.  However, there is a big difference between the two.  The spur that forms on the heel bone along the fascia attachment is PARALLEL to the ground, and essentially lengthens the weight bearing surface of the heel bone.  It does not stick down into the ground like a spike, jabbing the heel tissue with it.  The spur itself does not cause pain (unless it fractures, which is uncommon).  Therefore, to tell someone you have a heel spur, while it may be accurate, does not really explain exactly why you have pain.  In fact, I have seen thousands of x-rays of feet with heel spurs, and only a fraction of those actually had heel pain.  Because many people inaccurately connect heel pain to a perceived bone problem, there is an expectation of a more permanent nature to heel pain, or at least a need for more immediate surgical intervention.  The truth of the matter is that heel pain, or plantar fasciitis, is easily treated when one knows how to address the various components that go into the condition (inflammation, tissue injury, and abnormal foot structure).  Surgery is rarely necessary, and even when it is required due to failure of all other treatment the spur does not need to be removed.

I hope this clears up some confusion about heel pain.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
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A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.