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Plantar Fasciitis and Heel Spurs
What are plantar fasciitis and heel spurs?
Plantar fasciitis and heel spurs are problems that can develop in the area of the heel on the sole of the foot, causing chronic pain and interfering with the ability to walk normally or comfortably.
The plantar fascia is a band of fibrous connective tissue that, lying atop the cushioning layers of fatty tissue that constitute the bottom of the foot, extends from the heel bone to the ball of the foot. Stress from mechanical problems, injury or overuse can cause the plantar fascia to become inflamed, creating pain. Plantar means the bottom of the foot; fascia is a term for this kind of fibrous connective tissue that is found throughout the body; fasciitis refers to inflammation of the fascia tissue.
A heel spur is a calcium deposit — that is, a growth of bone — that can develop on the bottom of the heel bone where the muscles of the foot connect to the bone. This boney protrusion, which tends to resemble a hook or spur that points forward, can result from extended strain on the foot's muscles and ligaments, from the prolonged stretching and inflammation of the plantar fascia (that is, from plantar fasciitis), and from repeated tearing of the membrane that covers the heel bone.
While many cases of plantar fasciitis and heel spur can be dealt with through conservative, medical treatments, surgical correction may be necessary in some instances. The surgical podiatrists of Connecticut Surgical Group are both skilled and experienced in this area. CSG is among the first medical organizations to offer Extracorporeal Shock-Wave Therapy — the use of high-intensity acoustic or sound waves — to treat these problems. The term "shock" refers to the effect of the repetitive sound waves, not to electricity.
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How do the feet work?
Each of your feet has 26 bones, more than 30 muscles and numerous tendons and ligaments that work together to bear and propel your body weight during standing, walking and running. Bones provide support, ligaments provide stability and muscles and tendons provide movement.
Seven bones work together to make up the ankle and heel, including the calcanus bone, which represents the lower part of the ankle and the heel itself. It is this bone that bears most of the weight of the body in standing and walking. The fibrous connective tissue known as the plantar fascia stretches forward from this bone, supports the arch and extends to the forefront of the foot.
You place 1½ times your weight on your feet when you walk normally (and more when you run) and it's estimated that the average person walks for approximately 1,000 miles each year.
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What are the characteristics of plantar fasciitis and heel spurs?
The key sign of both plantar fasciitis and heel spurs is pain located directly underneath the heel (although it's entirely possible to have a heel spur without experiencing any pain or other symptoms). Initially, the pain may be mild — at this point such pain is often referred to as a stone bruise and it's likely to resolve with rest.
If you continue your stressful activity despite the pain, it can progress to the more serious development of plantar fasciitis and/or a heel spur. For this reason, it's important to give your feet the opportunity to recover from the moderate pain of stone bruises, and to seek treatment when pain continues before the condition becomes chronic. Generally, the longer you have had symptoms, the longer it will take to resolve the problem.
While resting your feet may give you relief, a characteristic of plantar fasciitis is that that relief tends to be only temporary, with the pain coming back as soon as you resume placing weight on your heels and, accordingly, stretch the plantar fascia. Although the pain usually diminishes after a few minutes, it will return again as your time on your feet goes on.
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What causes plantar fasciitis?
Plantar fasciitis usually develops as a result of prolonged or repetitive straining over an extended period that causes the tissues of the fascia to be torn or stretched, at various points along its length, resulting in painful inflammation.
Plantar fasciitis is perhaps most visibly associated with athletes whose activity involves them in a great deal of running or jumping, but anyone who stresses their feet — as in people whose work requires them to stand and walk on hard surfaces for extended periods — is vulnerable to the problem. Mechanical motion imbalances, excessive weight and ill-fitting or excessively worn shoes can be important factors.
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What causes heel spurs?
Heel spurs generally develop from stress on the muscles and ligaments of the foot, by plantar fasciitis — that is, inflammation of the plantar fascia caused by excessive, prolonged stretching and tearing — and by repeated tearing of the membrane that covers the heel bone. The same athletic issues that cause plantar fasciitis can result in heel spurs, and the same issues of mechanical motion imbalance in the feet, excessive weight and poorly fitting or excessively worn shoes can be significant factors.
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What are the major risk factors for plantar fasciitis and heel spurs?
You're more likely to develop plantar fasciitis and heel spurs if you have or engage in:
- Mechanical defects in your gait that creates stress on muscles, tendons, fascia and other tissues
- Vigorous exercise or other athletic activity that results in acute injury or prolonged stress on your feet
- Tight calf muscles that limit your ability to flex your ankles
- Excessive weight
- Poorly fitting or excessively worn shoes
- Activities, such as a waitressing job, that requires significant standing and walking on hard surfaces
- Very flat feet or very high arches
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How are plantar fasciitis and heel spurs diagnosed?
Your physician's diagnosis will start with a careful history as to when and how the pain occurs, stress factors such as occupational and athletic activities, the types and condition of shoes you wear and any injuries or other problems with your feet you may have experienced. Along with trying to palpate, or feel, any abnormalities, he or she may try to replicate the pain in order to define it. And, he or she will evaluate your range of motion in your ankle and your gait, or way of walking.
Your doctor may order x-rays of your foot to visualize any heel spur. Generally, a heel spur that will show up on an x-ray will have been present for at least six months and extend forward for about a half-inch.
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What are the treatments for plantar fasciitis and heel spurs?
The first treatments tried will most likely be conservative — that is, nonsurgical — approaches. These may include:
- Rest from athletic and other vigorous activities
- Icing the heel with cold packs or ice water
- Anti-inflammatory drugs such as aspirin and ibuprofen
- Padding such as heel cups to cushion and protect the heel
- Taping the foot to support the foot
- Stretching exercises to stretch the calf muscles
- Wearing more comfortable shoes, possibly shoes with higher heels, and especially running shoes that offer significant cushioning
If your treatment is successful, you should begin to see improvement in about six weeks. Depending on your response, your doctor will likely continue you on the above measures and may add:
- Orthotics, or inserts worn inside the shoes, to correct mechanical motion defects
- Cortisone injections to reduce inflammation for some patients
- Ultrasound, hydrotherapy or other physical therapy treatments to reduce inflammation
Again, depending on your response after several months, your doctor may continue the above and may add a cast or brace to immobilize your foot. And, he or she may suggest surgery or extracorporeal shock-wave lithotripsy. Following the treatment process outlined above, it's estimated that 90 to 95 percent of patients will resolve their symptoms within a year.
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What does surgery for plantar fasciitis and heel spurs involve?
While many cases of plantar fasciitis and heel spur can be dealt with through conservative, medical treatments, surgical correction may be necessary in some instances. The surgical podiatrists of Connecticut Surgical Group are both skilled and experienced in this area.
Surgery for plantar fasciitis involves a procedure to separate some or all of the fascia tissue from the heel bone. To do this, the surgeon makes a small incision on the inside or bottom of the heel to separate the targeted tissue from the bone.
Surgery for heel spurs involves a similar procedure focused on removing the boney protrusion. When the heel spur is associated with plantar fasciitis, both can be done in a single operation.
Both procedures are usually performed on an outpatient or day-surgery basis, lasting an hour or two and using a local anesthetic. Following surgery, you may have your foot wrapped or immobilized in a cast, crutches may be used as well. Recovery is usually accomplished in six to eight weeks.
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What is Extracorporeal Shock Wave Therapy for plantar fasciitis and heel spurs?
Extracorporeal Shock Wave Therapy (ESWT) is a new nonsurgical technique that is now being used in some patients for the treatment of plantar fasciitis and heel spurs. Connecticut Surgical Group is among the first medical organizations to use this technology to treat foot problems.
Literally, Extracorporeal Shock Wave Therapy means acoustic or high intensity sound waves delivered from outside the body ("shock" refers to the effect of the repetitive sound waves, not electricity). ESWT systems have been used since the 1980s to focus high intensity acoustic waves on kidney stones within the kidney to pulverize the stones and allow them to pass naturally as tiny grain-sized particles.
A side effect that was observed with this procedure was a healing effect on surrounding tissue. The continuous low-energy radio waves of conventional ultrasound have long been used as a tool for healing inflammation. For soft-tissue issues such as plantar fasciitis, ESWT represents an enhancement of this effect, generating higher-energy acoustic waves two or three times per second.
Taking approximately a half-hour, ESWT is an outpatient procedure performed under local anesthetic. A typical course of treatment involves one, possibly two, ESWT sessions, with results becoming apparent over a period of two to three months.
While return to normal activities can be expected the following day, vigorous exercise and other activities should be limited for a period of four to six weeks. Patients with problems such as bleeding disorders, diabetes and similar issues may not be candidates for this procedure.
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What can I do to prevent heel spurs from recurring?
The most important thing to do in order to avoid development of plantar fasciitis or heel spurs is to take care of your feet:
- Rest your feet and let them recover if you experience pain such as the moderate pain problem called stone bruise. A mild simple pain that is ignored can develop into a serious, complex problem. Pace yourself to protect your feet.
- Wear shoes that have shock-absorbent soles and provide good support.
- Replace shoes that have excessive wear on the heels and soles, or that don't provide adequate support.
- If your doctor has prescribed orthotics to correct structural or mechanical problems, be diligent about wearing them.
- Stretch before and after exercising, and begin and end gradually — warm up and cool down.
- Lose excess weight.
- If your heel problems reflect structural deformities such as extremely flat feet or very high arch, focus on activities that don't stress your feet, such as swimming and biking.
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For additional information
You can find additional information about plantar fasciitis and heel spurs at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations.
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Likely sources include:
The American College of Foot and Ankle Surgeons
(www.acfas.org)
The American Podiatric Medical Association
(http://www.apma.org)
The American Orthopaedic Foot and Ankle Society
(www.aofas.org)
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