Dr. Allan Horowitz, published newspaper article, The Liberal, Copyright August 14, 1991

Dear Dr. Horowitz:

Could you please help me figure out what is wrong with my foot. I am 46 years old. I stay active, playing baseball, soccer, tennis, and I sail quite a bit in the summer time. I am approximately 20 pounds over my ideal weight, but I have been this way for many years. I eat well, and I am in good physical condition. I have no other problems except for this one.

Whenever I walk for a long time the bottom of my heel begins to hurt. It feels like I bruised it, but I know I haven’t. I have tried buying new shoes, runners, expensive sandals, used two pairs of socks, put a-pad under my heel, and nothing has worked. (Actually, when I tried the pad under my heel it made it much worse). I went to my regular doctor who told me it was probably a piece of bone sticking out from my heel, and losing weight would help me.

Number One, I don’tunderstand how a bone, all of a sudden, starts to stick out from my heel. Number Two, I don’t know how losing weight will make that bone go away. Have you ever heard of anything like this, or did I misunderstand him?

Angelo M., Richmond Hill

Answer:

Actually, Angelo, I think we are all a bit crazy. But I’ll leave that for another article when I am in one of those “special moods.” This is probably one of those cases where your doctor tried to explain something to you in simple terminology, trying to make it easy for you to understand, but instead you think he is crazy.

It sounds very much like you have something called a “calcaneal spur” , commonly referred to as a heel spur. When there is a constant, long-term strain or pulling on the tissues on the bottom of the foot (plantar fasciae) a small bit of bone can “grow” on the heel bone, properly known as the calcaneus. This bone growth occurs when the plantar fasciae has been pulling at the calcaneus for a long period of time, usually years.

There really isn’t any surgical solution to this problem. Sometimes an injection of cortisone into the area around the spur alleviates the pain and local tenderness. This relief, if any, is usually short lived and should really only be tried if nothing else helps.

Applications of ice, accompanied by rest of the foot will usually help as much as anything in giving pain relief. The spur, once present, will be symptomatic from time to time, whenever the person stands or walks for too long a period of time. Reducing this activity usually helps prevent the flare-ups.

Application of ultrasound also works well to decrease the pain and tenderness, and makes it easier for the patient to walk without limping. Every profession has its own way of treating heel spurs.

ICE HEEL

Here’s what I recommend: rest and ice the heel (20 minute applications every few hours) as long as possible. Only wear comfortable, soft, but well-supporting running shoes. Have ultrasound treatments until the pain goes away, which is usually two to five treatments. If the pain flares up again a few months later, return for a few more ultrasound sessions.

The sooner you get it treated, the less time the disability usually lasts.

The reason the pad under your heel hurt you was because it was pushing up into the spur, therefore causing more irritation of the heel.

A pad shaped like a donut, or an “0” is what you should put under the painful part of your heel. This will allow the spur to sit comfortably in the centre of the “0” without it contacting the shoe.

In this column I have discussed the benefits of orthotics several times. Orthotics are devices to better balance the feet and ankles while in a weight-bearing position. Orthotics are often used to lessen the stress on the plantar fasciae, which is what caused the spur in the first place. Rather than treating the spur only, orthotics usually lessen the pull on the spur, and can actually prevent it from worsening with time. Orthotics can be made with that donut shaped support built in. Losing weight will obviously decrease the load on your heel spur and will therefore probably help to decrease the painful episodes.

A calcaneal spur is like most things in life – you can pay as much attention to it as you want.

If it only bothers you once in a while, and only causes you slight pain, then maybe some rest and ice, whenever it is hurting, is all that should be done.

If it bothers you almost constantly, and the pain is enough to actually make you limp, then maybe you should go the full route and have therapy done and have prescription orthotics made. The decision is all up to you.

Dr. Allan Horowitz, D.C., is a chiropractor practicing in Richmond Hill. Address your questions to Allan Horowitz, c/o The Liberal, P.O. Box 390 Richmond Hill, Ont. LAC 4Y6.