Q. Im a middle-aged man and dont do much exercise except for playing golf. But over the last few months I have developed pain in my heel that just wont go away. A friend of mine had a similar problem a couple of year ago and was told he had a heel spur. Is there anything I can do to get it to go away on its own? J.S., Houston.
A. A bone spur is a projection of additional bony material outside of the normal contours of a bone. It results from excessive pulling on the bone by ligaments and tendons where they attach to the bone.
In a heel spur, the extra growth of bone occurs on the bottom or back of the heel bone (the calcaneus). In this case, the excessive pulling is primarily from tendons and connective tissue that form the arch of the foot. Pulling by the very large Achilles tendon attached to the back of the heel also can cause bone spurs.
But heel spurs are only one of several causes of pain on the bottom of the heel. Similar types of heel pain can be caused by plantar fasciitis and bursitis.
The plantar fascia are the connective tissues that form the webbing on the bottom of the foot. Inflammation (itis) of this fascia can not only cause pain on its own but is also related to the formation of a heel spur.
Bursitis is the inflammation of a fluid-filled pocket that typically is found near the attachment of ligaments and tendons such as where the Achilles tendon attaches to the heel.
Heel spurs can be diagnosed during a physical exam (pressing on the heel often causes pain if a spur is present) and confirmed by X-rays.
Heel spurs are seen in athletes and non-athletes as well. They are usually painful as they develop, especially during walking. Because they are a result of repetitive pulling over time, even playing golf may increase the formation of heel spurs or bring out the symptoms, especially if youre not using a cart.
Often, the pain of heel spurs diminishes without treatment. The foot actually adapts to the spur, diminishing, though not always totally relieving, the pain.
Most bone spurs can be treated without surgery, but such treatment is usually focused on pain reduction. In addition to oral pain medications (usually nonsteroidal anti-inflammatory drugs), corticosteroids can be injected into the painful area of the heel.
Padding and special shoe inserts can be used to minimize the stretching of the connective tissue and to reduce pain. You should talk to your doctor, pharmacist or podiatrist about whats available.
Two non-surgical techniques, low energy extracorporal shock wave therapy (ESWT) and radiotherapy, have been providing good results in relieving pain and improving function. In both approaches the treatment has to be done multiple times over many weeks.
Because surgery is not always successful and pain may continue, surgical removal of a spur is usually only recommended in more severe cases.
As with any recommended medical treatment or surgical procedure, please be sure you understand the risks, benefits and costs before deciding. Also check the experience of the person doing the procedure and feel comfortable in getting a second opinion if you arent sure.
UPDATE ON TELEHEALTH: In this time of rapidly rising costs and a growing shortage of nurses, its critical that we adopt medical practice techniques that address both problems. A study done by the Pennsylvania Homecare Association shows that, fortunately, the use of telehealth does both.
By using equipment that transmits data over ordinary telephone lines, home health providers are able to assess, counsel and monitor patients remotely, resulting in decreased home health staffing needs by one-third.
And these same technologies can be used to better monitor everyone with major chronic diseases, decreasing the need for doctor visits and hospitalizations.