RIDING WITH SPURS

“Can you imagine, doctor?

As I woke up this morning, I couldn’t step on my heel! It hurts like hell! I mean, I’ve had some minor pain there for a couple of weeks, but it never lasted longer than an hour. The only thing I did last night was spend more time than usual cooking for my guests…”

Many of my patients with heel spurs come to the clinic after experiencing their first episode of acute pain. Others have already sought medical help, spent a long time on treatment, and now simply feel sick and tired of the disease and the remedies alike. These poor souls are anxious to tell me everything about their spur, point to it on an X-ray image, and tell me how sharp and evil it is. In most cases, they tried ultrasound or hormone injections to no avail.

What is a heel spur?

First of all, a heel spur is a combination of two medical conditions. The first one is the synovial bursa inflammation (bursitis) or periostitis, as well as degenerative and dystrophic changes (don’t be scared!) in tissues surrounding the spur. The second one is a spike-like osseous growth on the lower side of heel bones, i.e., the spur itself.

The scientific term for the heel spur is plantar fasciitis.

Curiously, this bone deformation is a consequence rather than the source of inflammatory changes in ligaments and the periosteum. The initial irritation is followed by a painful inflammation that is difficult to treat. The outcome is calcium deposits in the inflamed tissue and visible changes in X-ray images – the much-hated “spur”. It turns out that treating the spur itself makes little sense, because it does not hurt and sometimes shows in the X-ray images of patients who have no problem with it.

What a surprise! So, are these expensive and unpleasant procedures not necessary? That’s right, they are not, isn’t it a nice surprise? You do not need surgery on your foot do you need to have your spur removed with a chisel or ultrasound. What do you need then? Just to eliminate the inflammation and its sources.

Curiously, this deformation of the bone is the consequence rather than the source of inflammatory changes in ligaments and the periosteum.

The sources of disease

So, what are the reasons leading to those ugly heel spurs? First of all, we are talking about degenerative changes in the tendons and ligaments because of acute or chronic microscopic traumas. An acute trauma may be the result of a hapless landing after a parachute jump or a simple step down the ladder when your heel muscle gets overstretched or torn. Now it will not leave you alone for months and maybe even years to come.

This condition was first described by Pletner in 1990.

Chronic micro-traumas tend to affect people with obesity and flat feet who have to stand for hours, as well as those wearing shoes with flat soles. The mechanism is the same as with acute traumas, though in this case, microscopic changes accumulate from day to day to reach a critical mass and cause the pain described above.

Foot relief

Treatment in this case should address the core causes of the condition. First, reduce the demands on your feet: do not stand for too long, use every opportunity to sit down, or at least let your knees (or one of them) rest on a low stool. Losing even a few pounds may also significantly reduce the traumatizing load.

The main thing, however, is your choice of footwear. I helped several patients get rid of chronic pain in their feet simply by recommending they wear good slippers with extra arch support at home. Too many women walk barefoot at home or stand by the kitchen range after a whole day of standing at work. Remember that your muscles are not made of steel; they eventually get exhausted and succumb to inflammation.

I helped several patients get rid of chronic pain in their feet simply by recommending that they wear good slippers with extra arch support at home.

Cold water

Cold water is an excellent remedy against foot pain. As I have already said, foot pain stems from inflammation in the muscles and ligaments at the bottom of your feet rather than from bone deformation. This inflammation, in turn, is caused by stiffness in dilated capillaries, which barely afford any blood flow.

To enhance blood circulation and reduce edema, put the ailing leg into a cold tub for a minute or two, take it out, and give it a good rub with a towel. Repeat the procedure two or three times. The whole process will take 10 to 15 minutes at most. If you suffer from acute pain, give your foot a cold bath every 3 to 4 hours; otherwise, two or three times a day is enough.

Posture correction

Medical treatment of heel spurs also includes measures to reduce the load on the affected foot. The doctor would check the patient for pelvic tilts that may lead to functional leg length discrepancy. If this is the case, he would either select a special insole or use manipulations and exercise for spinal and pelvic realignment. Also helpful are special massage therapy and the mobilization of foot muscles and ligaments to restore their functions, improve lymphatic drainage, and accelerate the recovery of inflamed tissues.

The inflammation fire

A good combination of painkillers and anti-inflammatory drugs is also a must. Note that many natural and homeopathic remedies against inflammation have become available lately. If the pain is persistent, a radical procedure such as a steroid injection into its epicenter can be used. I make these injections with preliminary anesthesia to make them more palatable; some doctors believe that the pain shock involved also has a certain therapeutic value. I beg to differ.

As for steroids, generally, they can indeed alleviate inflammation. On the other hand, in the long term, these drugs may accelerate and enhance degenerative changes in your ligaments and make them more vulnerable to trauma.

I have a different approach: my goal is not only to extinguish the fire of inflammation but also to restore damaged tissues as much as possible, while maintaining their elasticity. That’s the only way you and I can extend their life span – and boost the quality of your life.

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