What You Need to Know About Heel Spurs
The feet are probably the most important body part for everyone, whether you are an athlete or not. They are the joints that work the hardest and support our entire bodyweight. For this reason, the foot and ankle are a commonly injured body part. People who regularly stand during their jobs, such as nurses and construction workers, are usually the victims of foot pain. Distance running is a sport that requires constant pounding on the ground with our feet, creating significant pressure that leads to foot pain as well. Depending on many biomechanical factors and foot care regimens, there are several diagnoses that can occur in the foot and ankle joint in runners.
The most common diagnosis in runners’ feet is plantar fasciitis. This condition often mimics other issues in the foot such as tendonitis and bone spurs. Symptoms for this condition are usually pain in the arch and/or heel of the foot that is worse in the morning when first walking or after prolonged sitting. Once it warms up after several steps the pain eases. Running is usually painless with plantar fasciitis, whereas with other conditions, such as bone spurs and stress fractures, the pain will limit running. Therefore this condition is likely almost ignored in runners since they are usually able to get through their training without pain. Over time the pain from plantar fasciitis will worsen and can lead to other issues such as tears and chronic inflammation that will be debilitating at all other times of the day.
Plantar Fasciitis or Heel Spur?
Most runners will look up their foot symptoms and diagnose themselves with plantar fasciitis and begin managing their pain with what they find under this condition. The common treatment strategies for plantar fasciitis consist of icing, rolling a tennis ball under the foot to loosen the tension, and stretching the calf muscles. These are good treatment strategies for most foot conditions but if the pain does not seem to relieve and running becomes difficult to get through, most likely the issue is not plantar fasciitis.
Heel spurs are basically a calcium deposit that causes a bony lump and is a common finding in X-rays. Almost 40% of people have heel spurs, but are not even aware, because most do not have any pain at all. The pain of a heel spur is only present when it is in the process of growing, unless there is a great deal of inflammation in the surrounding areas. Heel spurs are caused by prolonged straining of ligaments and tendons in the foot, excessive stretching of the plantar fascia, or tears in the protective tissue of the heel bone itself. It is safe to say that poor treatment and chronic plantar fasciitis can most definitely lead to the formation of a heel spur.
Risk Factors & Treatment Options
Besides being a runner other risk factors for developing heel spurs are being overweight, wearing improper or badly worn shoes, having high arches or flat feet, and gait mechanics involving excessive pronation. Of course it is ideal to prevent heel spur formation so making sure to rotate and change running shoes frequently and maintaining a healthy bodyweight are the easiest strategies. Once the heel spur begins growing and it is causing pain, it is important to prevent the continued formation of the spur. This is really only possible if you are able to stop training for several weeks, so that all pressure on the foot can be relieved. In most cases, the foot is placed in a boot or other brace for two to six weeks.
Treating While Training
Decrease Pressure & Inflammation
If an athlete is unable to be immobilized or chooses to not stop their training, the only remedy is to take as much pressure off of the spur itself during the activity. Orthotics such as gel heel cushions can be helpful although it can sometimes increase the pressure on the spur. The best approach is to cut a hole in the orthotic insert where it would be applied on the spur so that pressure is taken off of the painful area during running. Besides this “active immobilization”, the next treatment approach is to include modalities to decrease inflammation. Icing several times per day is necessary, especially immediately after running or any activity that exacerbates the pain.
As with any diagnosis it is always important to understand the cause of your condition in order to treat the issue properly. If the cause of the heel spur was chronic plantar fasciitis, as is the most common cause for runners, then treating the plantar fascia tightness is the first plan of action. Rolling your foot over a tennis ball or other massage tool is a perfect way to loosen the fascia and break up any adhesions. Using a frozen water bottle for a few minutes in the same way will do the massage and icing all at once to save time! Another self-stretch technique for the plantar fascia is the pull the toes up towards the shin to feel a stretch on the arch of the foot. This can also be done in a standing position placing weight through the toes for a stretch. A common cause of plantar fasciitis is tightness in the calves and Achilles tendon, so proper stretching for these muscles is essential before and after running.
The next treatment approach should focus on strengthening the weak ankle and intrinsic foot muscles. Calf and dorsiflexor (the muscles along the shin bone) strengthening is important for ankle stability, but it is the weak tiny foot muscles that are commonly overused causing plantar fascia problems. Easy exercises for these muscles are “gripping” movements such as placing a small towel on the floor and trying to pick it up with the toes while the heel remains planted on the ground. Ankle exercises, such as the ones below with a resistance band, will help target the higher stability muscles. After a few weeks of these basic exercises, it is beneficial to include movements while standing on an unstable surface. A balance disc is a good tool for lower body moves such single leg squats and leg lifts, or single leg standing while performing upper body exercises.
Although the ideal treatment strategy for a heel spur is to stop the formation with immobilization, athletes do have the choice of approaching treatment while continuing to train. Pain management is the obvious goal but the exercise portion of the treatment plan is the most important, as heel spurs will end up continuing to form if the cause is not addressed. Keep in mind that the heel spur itself is not the cause of the pain, it is the growth process that hurts. Foot pain is not always plantar fasciitis, so it is important to note the differences in order to take care of the problem. The response to foot pain for runners should definitely never be to ignore it and push through the pain, because as mentioned above, the feet are the foundation of the body. Poor foot care will only lead to issues and pain elsewhere and most likely time off of training.
- Painful Plantar Heel, Plantar Fasciitis, and Calcaneal Spur: Etiology and Treatment, Journal, Jan 07, 2018 ,