Heel Spur Syndrome
Wolff’s Law is a simple ideology that states that the natural bone of a healthy animal or person will adapt to the stress under which it is placed.
When the joints start to lose their cartilage, arthritis starts. When you get bony ends constantly rubbing against one another this creates friction. This friction will lead to bone spurs around the joint.
This is the basis of where a spur comes from around a bone. I often get patients who come in for an appointment with something called heel spur syndrome. This they have either had diagnosed from their primary care physician who took the x-ray, or they assume they have by reading google or looking at their x-rays themselves. There are few different places that a spur will develop in the foot. One of the more common areas is along the plantar heel.
This spur develops due to a pull against the plantar fascia. A heel spur is parallel with the bottom of the heel and runs in the plantar fascia. A spur by itself does not cause pain. The pain you experience in the heel is due to the inflammation around the plantar fascia, not the spur. The spur does not cause inflammation in the plantar fascia. There are several people who will live with a heel spur and never have pain. The procedures we use to correct the plantar fasciitis does not involve the heel spur. If you have further questions about plantar fasciitis please refer back to the plantar fasciitis blog, or contact our office for an appointment and we can evaluate your heel pain and determine the cause and best course of action for treatment.
As I stated above there are other areas in the foot where spurs can develop. Another common area is the posterior heel. These spurs usually occur due to a short tight Achilles tendon. When the tendon is short and tight it can pull against the back of the heel bone. This can create tension in the bone leading to a spur. This spur is painful, unlike the spur along the plantar heel.
This is because it occurs at the attachment sight of the Achilles tendon, and the bursal sack that sits between the tendon and the heel. This spur can get into the bursal sack and create inflammation. We also see problems due to the heel counter in the shoe placing pressure to the back of the spur. This spur is sometimes called a pump bump. This spur is difficult to treat conservatively. We can try immobilization in a boot, PT, heel lifts, stretching and NSAIDS. It is a high risk to perform a steroid injection near the Achilles tendon as it can weaken the tendon and lead to a rupture. Often, we see with conservative care that once you return to regular shoes and activity over time the inflammation and pain return. The problem with this cyclic return of inflammation, is that with every bout of inflammation it can weaken the tendon. This weaking of the tendon can lead to a rupture of the tendon. This is a rupture due to a chronic inflammatory condition. Therefore, it is not a clean rupture but will be a rupture that will destroy the tendon. To repair this, we would have to perform either grafting of the tendon or a tendon transfer. Many patients opt for a surgical correction of this spur, to avoid the cyclic inflammatory issue and risk of rupture. This procedure consists of lengthening the tight tendon, repair the tendon and removing the heel spur.
The other areas of spurring we see in the foot are around arthritic joints. When the joints start to lose their cartilage, arthritis starts. When you get bony ends constantly rubbing against one another this creates friction. This friction will lead to bone spurs around the joint. The joints that have the most pain and problems with this spurring are the joints across the top of the foot and the first metatarsal phalangeal joint.
These joints are found along the instep of the shoe and the toe box of the shoe. So, the spurs can create irritations in the soft tissues that travel over the top and around the spurs due to the pressure the shoes create. This type of spurring is also very difficult to treat conservatively. It often requires a surgical correction, whether that is simply shaving down the spurring or addressing arthritis with either osteotomies or fusions.
