Heel Pain – Heel Spurs

Many people complain of painful heels which bother them a lot. Many conditions result in heel pain.

1. Plantar fascitis, inflammation of soft tissue fascia present in sole, at its attachment to heel bone (calcaneum).
2. Calcaneal spur, bony outgrowth at the under-surface of heel bone.
3. Compression of a small nerve in that area
4. As part of rheumatoid arthritis (RA)
5. Hyperuricaemia (raised uric acid) / gout

Many persons have some deformities of foot, mainly related to arches, which result in plantar fasciitis or bony spurs. The pain is worst at the time of getting out of bed with first contact of heel with the ground. It becomes less with some movements but does not disappear completely. Similarly pain is more after a spell of rest on bed or chair. Again it improves by walking.

It is a common concept that bony spur is the main cause of pain. Many people have spur without any symptom when they get x-ray of heels for other reasons. Yet another finding is pain on one heel and spur on the other side.

Treatment

1. Medications for pain
2. Weight reduction for obese persons
3. Change of footwear if required
4. Use of soft heel pads (e.g. silicone heel pads)
5. Medications and diet control for uric acid if it is raised
6. Hot water fomentations

Cortisone injections are given by some doctors, however I do not advocate this. Similarly in my opinion surgical excision of spurs is not required.

Quite a few patients are not able to get silicone heel pads due to financial constraints. For them I recommend make-shift economical arrangement. Simple rubber slippers are common in Asian countries and are quite cheap. Just cut the heel part of slippers and make round full-thickness hole in both. Then put these under the heel in the shoes. The painful part of the heel is off-loaded.