Heel spurs are the best known heel problems. A heel spur is a point of excess bone growth on the heel. The bone growth usually extends forward towards the toes. Heel spurs are visible on Xray.
The most common heel problems are actually caused by a painful tearing of the plantar fascia connecting the toes and the heel. (Plantar refers to the bottom of the foot and fascia is a type of dense fibrous connective tissue.) This may result in either a heel spur or plantar fasciitis.
If your foot flattens or becomes unstable during critical times in the walking or running cycle, the attachment of the plantar fascia into your heel bone may begin to stretch and pull away from the heel bone. This will result in pain and possibly swelling. The pain is especially noticeable when you push off with your toes while walking. Since this movement stretches the already inflamed portion of the fascia. Without treatment the pain will usually spread around the heel. The pain is usually centered at a location just in front of the heel toward the arch. When the tearing occurs at the bone itself, a the bone may attempt to heal itself by producing new bone. This results in the development of a heel spur. Without the spur the condition is called plantar fasciitis.
The pain of this condition may cause you to try to walk on your toes, or alter your running stride and gait which will cause further damage and may cause a problem to develop in your healthy foot. Gait changes in running may also lead to ankle, knee, hip or back pain.
Cause
The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. For more details on pronation, please see the section on biomechanics and gait.
The mechanical structure of your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major affect on their function and on the development of mechanically caused problems. Merely having "flat feet" won't take the spring out of your step, but having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should be stable as you are walking or running. This "hypermobility" may cause other bones to shift and cause other mechanically induced problems.
Other factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Make sure your shoes are not excessively worn. These shoes and other shoes that are not sufficiently controlling of pronation combined with an increase in training can lead to this condition. A change in running style, such as starting speed work, running on the ball of your foot or sudden increase in hill workouts.
Self Treatment
As with most running related injuries, an evaluation of changes in your training should be done. A decrease in workout intensity and duration is important. The most important part of self treatment for this condition is being sure that your shoes offer motion control and are optimal controlling the forces that contribute to plantar fasciitis and heel spurs. Check your running shoes to make sure that they are not excessively worn. They should bend only at the ball of the foot, where your toes attach to the foot. This is vital! Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this.
Plantar fasciitis is usually controlled with conservative treatment. Following control of the pain and inflammation an orthotic (a custom made shoe insert) will be used to stabilize your foot and prevent a recurrence. Over 98% of the time heel spurs and plantar fasciitis can be controlled by this treatment and surgery can be avoided. The orthotic prevents excess pronation and prevents lengthening of the plantar fascia and continued tearing of the fascia. Usually a slight heel lift and a firm shank in the shoe will also help to reduce the severity of this problem.
The treatment plan that seems to work best, with better than a 98% success rate includes carefully following a program of physical therapy and strappings of the feet. The physical therapy modalities most frequently used include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and galvanic ( a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm which is a contributing factor to the pain). This treatment has been found most effective when given twice a week. The felt pads that will be strapped to your feet will compress after a few days and must be reapplied. While wearing them they should be kept dry, but may be removed the night before your next appointment.
It is important to be aware of how your foot feels over this time period. If your foot is still uncomfortable without the strapping, but was more comfortable while wearing it, that is an indication that the treatment should help. Remember, what took many months or years to develop can not be eliminated in just a few days.
Iceing after running can also be helpful. Calf stretching should also be done. To strengthen the muscles in your arch toe curls can be done. Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may also be done without the towel.
from Dr Stephen M.Pruit