Are you suffering from painful sensations in your heel that are too discomforting in the mornings and seem to worsen only with activity? Watch out, for these are the classic signs of a common painful condition of the foot known as Heel spur. Get complete information about this disorder, including its causes, symptoms, diagnosis and treatment options.
What is a Heel spur?
It is a condition of the foot that is characterized by a small bony projection on the heel bone or calcaneus. The disorder is also known as Calcaneal spur.
Heel spur ICD 9 Code
The ICD 9 Code for this foot condition is 726.73.
Heel spur Incidence
The exact prevalence of this disease is not known. However, it is supposed to be a very common condition and is often observed in people suffering from Plantar fasciitis – a disease that arises in 1 out of every 10 adults in the United States.
The incidence of the disease is believed to be higher in women due to the types of footwear they often wear on a regular basis.
What Causes Heel spurs?
The condition manifests as an abnormal growth or projection in the heel bone due to accumulation of calcium when the plantar fascia gets pulled away from the heel. The plantar fascia refers to a broad fibrous tissue band situated along the underside of the foot that extends to the forefoot from the heel. The stretching of this band of tissue usually occurs due to flat feet or over-pronated feet. However, the condition may also develop in individuals suffering from Pes cavus or abnormally high arches.
The plantar fascia is strong and flexible. It supports the arch of the foot. However, certain factors may give rise to inflammation and irritation at the point of joining of the fascia into the heel bone. Such factors include:
- Abnormal stress
- Excessive weight
- Painful stretching
- Poor foot function
- Micro-tearing of the Plantar Fascia
Constant pull on the fascia at the heel bone ultimately results in the development of bone spurs or bony projections on the heel area. Generally, the cause of heel pain is not the spur itself but the soft-tissue injury that is related with it.
A spur usually develops on the heel when the heels and the foot are not properly cared after. If is often deemed to be an injury occurring due to repetitive stress. Due to this reason, lifestyle modification is typically considered to be the most basic strategy at managing this disease.
Heel spur Symptoms
The condition can lead to acute pain in the rear part of the foot, particularly when an affected person is walking or even standing up. Most patients experience pain in their heel spur as they get out of their bed in the morning. The condition exhibits itself through piercing, stabbing pain at the front or the bottom of the heel bone. The pain generally subsides after some time and turns into a dull ache. It usually returns when the sufferer gets up after sitting for a prolonged duration.
The Plantar fascia tightens and becomes short at the time of rest. When body weight is suddenly rested on foot, the Fascia might get stretched and lengthened quickly. This leads to its irritation and rupture. It is due to this reason that piercing pain is experienced with the first steps taken in the morning.
A person is at greater risk of developing heel spurs if:
- He/she is overweight
- He/she is pregnant
- He/she has tight calf muscles
- He/she is walking or standing on hard surfaces for long durations
- He/she is suffering from over-pronation or flattening of the arch
Although the condition often does not give rise to any symptoms, it may be associated with chronic or intermittent pain. Painful symptoms often arise at the time of running, jogging or even walking – if swelling occurs at the site of spur formation.
Risk Factors for Heel spurs
The susceptibility to this disorder is increased by factors like:
- Wearing poor-fitting shoes or bad footwear, particularly those that lack proper arch support
- Jogging or running, particularly on hard surfaces
- Excess body weight
- Abnormalities in gait, that put undue stress on the ligaments, heel bone and nerves located close to the heel
The condition is especially common in athletes and sportspersons whose activities include a lot of jumping and running. The problem is often caused by stretching of the Plantar fascia, strains on ligaments and muscles of the foot and repeated rupture of the membranous covering of the heel bone. Such issues lead to calcium deposits on the lower side of the heel bone, which occurs over a course of many months.
Diagnosis of Heel spurs
The condition is not always easy to detect, particularly in cases where patients suffer from other ailments of the foot. Physicians usually diagnose the disorder by simple physical observation of the affected foot. They look at the appearance of the heel in which patients complain about problems. If a spur is present, touching the region would make doctors feel a protrusion.
Doctors also typically ask patients about their symptoms. A sharp, stabbing pain in the heel – especially in the mornings, is a sign of this condition. Patients often describe a pain in their heel protrusion as a sharp ache that gradually fades to a dull pain. The pain, however, increases with activities like walking and standing. If you are experiencing such problems, you are suffering from a heel spur in all likelihood.
Treatment of Heel spurs
The condition can be treated through non-surgical as well as surgical procedures.
Non-invasive techniques involve:
- Losing excess body weight, through workouts
- Stretching exercises
- Orthotic shoe-insert
- Application of ice (for only 4-5 minutes) to make the inflammation subside
- Rest or avoidance of prolonged activities, such as running, jumping, walking or sports activities
Heel cups and cradles that provide cushioning and comfort to the heel and reduce shock to the region can also help patients effectively manage the symptoms of the problem. Correction of foot abnormalities through orthotic insoles is regarded as the most effective way of curing the underlying cause of this disorder. The key to the proper cure of this disorder involves determining the actual cause of the excessive stretching of the Plantar fascia.
Non-invasive cure also involves treating patients with medications. Over-the-counter medicines like Naproxen (Aleve), Ibuprofen (Advil) or Acetaminophen (Tylenol) can improve the condition of sufferers. In some patients, a corticosteroid injection may help provide relief to the inflamed region.
If non-invasive or conservative methods fail to cure the symptoms of Calcaneal spurs, surgery may be required to restore mobility to patients and provide them with relief from pain. Surgical procedures involve removal of a spur and release of the Plantar fascia.
In the majority of sufferers, plantar fascia release (whether or not spur is removed) is found to yield effective results. However, it is necessary to check whether patients are fit for this process. This can be done with the aid of pre-surgical exams or tests. It might be essential to implement RICE (Rest, Ice, Compression and Elevation) in patients after surgery. Physicians have to guide sufferers on when to place weight on the operate heel after operation. In some post-surgical cases, patients may require the use of supportive devices like:
- Surgical shoes
Complications of Heel spur
Some of the probable complications of this condition include:
- Nerve pain
- Permanent numbness of the area
- Recurrent heel pain
If there is release of plantar fascia, there can be added risk of stress fracture, foot cramps, tendinitis and foot instability.
Prevention of Heel spur
This extremely discomforting and painful condition can be avoided by wearing supportive heel counters, rigid shanks and shoes that have shock-absorbent soles and fit properly. Those who have a habit of wearing footwear with very high heels and soles should settle for a less high shoe. If the problem arises due to obesity, you should exercise regularly or on most days of the week to shed excess flab as well as retain a normal body weight.
In case you are already suffering from constant heel pain, begin practicing exercises for the calf and the foot. This would help strengthen the muscles in your lower legs and calves, thus taking stress of your heel bone and preventing the development of spurs.
Exercises for Heel spurs
These are some effective exercises of the foot that help patients of Calcaneal spurs manage their condition as well as normal individuals to evade the problem.
The steps to perform this workout are as under:
- Stand about 1 to 2 feet from a wall.
- Stretch out your arms and lean against the wall.
- Place one foot beneath your shoulders; position the other behind your body
- Keep your back foot planted flat on the ground to experience a stretch in the Achilles tendon or the back of your heel
- Hold the stretch for 10 seconds. Repeat the procedure with the other leg. Let both sides work for an equal number of repetitions.
You can let this stretch work even more by pointing the knee of your back foot down towards the ground and keeping the foot flat over the floor at the same time.
The steps for this simple yet highly beneficial workout are as follows:
- Place a towel or sheet on the floor. Sit down by its side.
- Pick up the towel and hold its ends. Loop the middle of the cloth around the toes of one of your foot.
- Keep your toes pointed up and your knee completely straight
- Pull the ends of the towel to pull your toes towards yourself. This will stretch the bottom of your foot as well as the back of your leg.
- Repeat the workout, this time with the other leg. Perform equal sets of the exercise with both legs.
If you are being guided by a physical therapist, you may also ask for a rubber Thera-band. This can be a great substitute for a towel although the latter is more easily available.
Cross Leg Stretch
The stepwise directions for this exercise are given below:
- Sit down on the floor as gently as you can.
- Bend one leg over another.
- Grasp your foot.
- Pull up your toes towards the shin and at the same time, hold your foot with the other hand.
- Experience a stretch on the bottom area of the foot
Hold this position for 10 seconds and experience the stretch along the arch of your foot. Repeat the workout for a minimum of 3 times on either side.
How to Heal Heel spurs?
The condition can be healed with the aid of:
- Ice packs
- Stretches and Exercises
- Anti-inflammatory medicines
- Night splints
- Shoe inserts
Prognosis of Heel spurs
The symptoms of this heel condition do not go away quickly. However, proper treatment helps cure the condition in most sufferers. Most patients get relief from the symptoms within three months. About 90% of sufferers tend to recover within one year.
Heel spurs Pictures
Take a look at these carefully selected pictures of Heel spur patients to know about the physical appearance of bony projections of the heel. These images would help you understand whether you or anyone in your family is suffering from this discomforting foot disorder.
Picture 1 – Heel spur
Picture 2 – Heel spur Image
If you are experiencing problems in your heel region, do not neglect your health. Consider the possible causes for your condition and try altering your footwear as well as modify your lifestyle in the most appropriate way to help the condition resolve naturally. However, you should get in touch with a professional healthcare provider as soon as possible if the symptoms do not show any sign of going away. Timely treatment and care would help you retain the function of your foot and prevent possible complications in future.
Written by Shoummojit
on September 12th, 2012. The article was last updated on September 12th, 2012