Bone spurs (retrocalcaneal spur, or exostosis) can develop not only on the back of the heel, but also on the toes, mainly around the fifth (small) toe. Most often, they occur next to the toenail on the outside of the toe; on the inside of the toe near the tip, where the fifth toe presses against the fourth toe; and on the inside of the base of the toe. Bone spurs can also occur on the sides of the toes. This is usually due to wearing shoes that are too tight in the toe box, which causes the toes to press against each other. Bone spurs may also develop in the arch area of the top of the foot; this area becomes painful when you tie your shoelaces tightly or exert other pressure on that part of the foot. Formation of spurs in this area is often associated with arthritis.
Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.
Most heel spurs cause no symptoms and may go undetected for years. If they cause no pain or discomfort, they require no treatment. Occasionally, a bone spur will break off from the larger bone, becoming a ?loose body?, floating in a joint or embedding itself in the lining of the joint. This can cause pain and intermittent locking of the joint. In the case of heel spurs, sharp pain and discomfort is felt on the bottom of the foot or heel.
Diagnosis of a heel spur can be done with an x-ray, which will be able to reveal the bony spur. Normally, it occurs where the plantar fascia connects to the heel bone. When the plantar fascia ligament is pulled excessively it begins to pull away from the heel bone. When this excessive pulling occurs, it causes the body to respond by depositing calcium in the injured area, resulting in the formation of the bone spur. The Plantar fascia ligament is a fibrous band of connective tissue running between the heel bone and the ball of the foot. This structure maintains the arch of the foot and distributes weight along the foot as we walk. However, due to the stress that this ligament must endure, it can easily become damaged which commonly occurs along with heel spurs.
Non Surgical Treatment
Podiatric Care for heel spur syndrome may involve keeping the fascia stretched out by performing exercises. Your doctor may also suggest for you to be seen by a physical therapist. You probably will be advised on the best shoes to wear or some inserts for your shoes. Your podiatrist may suggest that a custom made orthotic be made to allow your foot to function in the most ideal way especially if you have excessive pronation. A heel lift may be used if you have a leg length discrepancy. Medical treatment may include anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling and decrease pain. If a bursitis is present the medication may greatly improve the symptoms. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.
In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.
You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities. Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.