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Heel spurs causing foot pain

Dear Dr. Dave and Dr. Dee,

I am an early middle-aged female who is experiencing on going pain from what my doctors have told me is heel spurs. Actually, she told me the medical name for it, but I can't remember what it was. Anyway, I have pain along the sole of my foot and heel, especially during walking. I have tried orthotics for a number of years and they are no longer helping me. My doctor states I have to live with it for the rest of my life. I am asking you for your suggestions. Thank you.


Gimpin' in Atlanta

Dear Gimpn' in Atlanta,

This might be a good time to talk a little bit about heel spurs, the condition which is properly known as plantar fasciitis. This is an inflammation of the ligamentous structures along the sole of the foot, which causes pain especially with stretching, which occurs unfortunately with just about every step. It can be a very painful and chronic situation. The inflammation is often made worse by overuse, poorly fitting shoes with inadequate arch support, obesity that places an increased load on the foot and other causes.

Physicians diagnose plantar fasciitis, and exclude other causes of pain in the foot, by taking your history, doing a careful physical examination, and taking an x-ray of the foot. The x-ray often shows an osteophyte or exostosis on the heel bone, sometimes called a bone spur or heel spur hence the popular name.

The heel spur is not the cause of the pain. It is a result of chronic inflammation at the point of origin of the plantar fascia, but does not in and of itself cause pain. Part of the body's natural response to chronic inflammation is the laying down of microscopic calcium deposits at the site of the insult. Over time, if the inflammatory situation remains chronic and ongoing, then the calcium deposits can accumulate to the point that they are visible on x-ray as an osteophyte or spur. Since the heel spur is the result of, and not the cause of, the pain process, surgery aimed only at removal of the spur isn't generally warranted. But surgical decompression of the plantar fascia by endoscopic fasciotomy, or other surgeries, may be performed in appropriate cases.

Commonly prescribed interventions include the judicious use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients without contraindication, custom foot orthotics, and if indicated, weight reduction.

It's also important to take the initiative and make sure you have been diagnosed properly. People with foot problems often fall through the cracks because they don't get to see a specialist. So, a word to the wise: people with foot ailments who aren't satisfied with the results from their usual doctor should see a foot specialist called a Podiatrist (D.P.M.). These specially trained clinicians specialize in all modalities of treatment of disorders of the foot and structures below the knee.