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November 30, 2014
Category: Heel Treatments

HEEL PAIN is one of the most common problems seen in the Podiatry office.  The problem is that pain in the heel is often not related to what shows up on an x-ray of the foot.  There are TWO places on the foot where a "spur" is commonly seen.   The most common is on the bottom of the foot and is referred to as a Plantar Heel Spur.  The other, located on te back part of the heel is called a Retrocalcaneal Spur.  There are a few similarities in these spurs, and a number of differences.  The first thing to be aware of is that PAIN on the BOTTOM of the heel has NOTHING TO DO WITH THE SIZE OF THE BONE SPUR!  At one time, surgery was done on the bottom of the heel when a very large spur was present.  Baseball great, Joe DiMaggio had surgery on the bottom of his heel through a very large incision and it is felt by many that his baseball career ended because of that!  The presence or absence of a spur on the bottom of the heel is NOT a good indicator of what should be done to treat the heel.  Many spurs on the bottom of the heel have NO PAIN associated with them, and in infact PAIN ON THE BOTTOM OF THE HEEL IS FROM PLANTAR FASCIITIS (a mechanical tightness and subsequent pain that develops from mechanical causes) and has NOTHING TO DO WITH THE PRESENCE OR ABSENCE OF A SPUR!  It is true that MOST people with Plantar Fsciitis also have a spur, but many people with a spur on the bottom of the heel have NO pain.  If the decision IS made to do surgery on the bottom of the heel, removal of the spur is not even necessary.  It is cutting of the plantar fascia or tight ligament that leads to resolution of pain when surgery is done.    Pain in the back of he heel SOMETIMES is from the presence of a spur on the back of the heel.  It is also true that MOST of the time, the larger the spur on the back of the heel, the more likely it is to hurt.  I would also say that the larger a spur on the back of the heel is, the more likely it may need to be surgically removed.  Not all large heel spurs on the back of the heel are painful, and when they are, conservative treatment should always be tried first, but it is true that if there is a large painful spur on the back of the heel, and it has been painful a LONG time, it is more likely to need surgery.  There is little soft tissue protection between the back of the heel bone and the skin, so a large spur becomes very prominent and pressure causes pain.  Additionally, cortisone or steroid injections, which are often used on the bottom of the heel to relieve pain, cannot safely be used on the back of the heel.  A big part of the problem with the back of the heel is the Achilles Tendon.  This is the LONGEST and STRONGEST tendon in the body, but also very vulnerable to injury.  Steroid injections can cause a spontaneous rupture of the Achilles tendon.  There are still many ways to treat either type of heel pain.  These included over the counter arch supports and insoles, custom orthotic devices,physical theapy, shockwave treatments, night splints, stretching exercises, PRP (Platelet Rich Plasma), several other NEW alternative treatments such as Ozone and Stem cell injectons, and...if all else    The FIRST thing, is to be seen  a specialist to ge an accurat diagnosis, and then treatment can be started.  One of thmost important things when dealing with heel pain is to BE PATIENT.  Sometimes the first treatment will get alleviate all of the pain, but in many cases a multifacted approach is needed. 


Richard S. Eby, DPM

(423) 622-2663