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Then why do you have heel pain?

Does your foot hurt when you take the first step out of bed in the morning?

When you walk around does the pain ease a bit,  then after sitting  it starts hurting when you get up again?

If so, you have typical HEEL SPUR SYNDROME.

An x-ray will probably show a heel spur, which is actually an elongation of the bone.  However the spur is not what hurts.  There is a ligament which attaches to the heel bone and extends to the toes.  If you pull your big toe up you will feel how tight the ligament gets in the arch area.  This structure is tough like leather.  It does not stretch but it rips.  It usually rips at the weakest point which is where it attaches to the heel bone.  As the fibers rip a spur grows.  The body tries to protect itself by making a small sac of fluid called a bursa.  The bursa acts like a pillow in the area of the spur.  When a bursa is inflammed we add itis to its name...thus becoming bursitis.  Most people are familiar with bursitis in the shoulder or the hip.  These are usually treated with a shot of cortisone.

When heel spur syndrome is diagnosed I will do three things.

  1. Take an X-ray to confirm the diagnosis and get some idea of the cause (such as pronatory imbalance in the foot structure).
  2. Do something to stop the ligament from pulling on the heel bone.  Sometimes padding and strapping,  arch supports, and maybe apply a soft cast.
  3. Reduce the inflammation with medicine similar to motrin,  apply physiotherapy and sometimes injection of cortisone and novacain

Sometimes one treatment gets rid of the problem, but don't hold your breath.  On the average I find 3 to 4 weeks of the above treatment along with custom arch devices called orthotics will give long term relief in eight out of ten cases.  The remaining heel sufferers eventually undergo surgery.


Not so long ago the surgery involved making a large incision around the heel,  peeling off the skin and removing the bone spur.  Jolt'n Joe Dimaggio had this done and it ended his career.  Over the years podiatrists observed the results of the surgery and realized that good outcomes could be gotten even when the spur was not removed.  Remember I told you it's not the spur that hurts.  We found that by releasing the tight ligament (the plantar fascia) the pain was relieved.  Today we use modern endoscopic methods, similar to Knee surgery, to release the fascia.
A tiny puncture is made on both sides of the heel.  Then using a mini T.V. camera and tiny blade the surgery is accomplished.  You can walk immediately and return to normal activities shortly after surgery. I have found the rate of improvement to be over 80%.


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