Take Me To Post Comment Form Although sometimes told it’s the only alternative, in over thirty years of foot and ankle surgery, I’ve only had to operate on a handful of patients with heel spurs.

Heel spurs occur in two common areas; the backs and the bottoms of the heels. Most often when people are told they have a heel spur it’s the bottom of the heel that they’re referring to.

Heel pain can be indicative of a wide variety of rheumatological (arthritic conditions) such as rheumatoid arthritis and osteoarthritis. Abnormal compression of the nerves (tarsal tunnel syndrome) as well as arterial diseases can also cause pain on the bottom of the heel (although with decreased blood flow, symptoms are usually more in the arch of the foot).

But the most common cause of pain under the heel is pronation or a flattening of the foot. There is a band of tissue under the arch (plantar fascia) that acts like a rubber band, and when the foot flattens that band is stretched. It begins to pull at its attachment under the heel and in severe cases this constant pulling can cause a bone spur to form.

A bursa (fluid filled sac) may also develop and when it becomes inflamed, it can make walking very difficult. Pain is usually worse in the mornings or after sitting for a while. Although the flattening of the foot is the direct cause, a determination must be made as to why this is happening rather than simply treating the heel pain with cortisone injections and other modes of therapy.

Although often overlooked, in almost all cases a tight calf muscle is the primary cause of heel pain. This forces the foot to pronate or roll inward more than it normally would. Usually, simply stretching the calf muscle dramatically decreases the symptoms. In severe cases, a painless trigger point injection (of a local anesthetic) can relax the calf enough to begin proper stretching.

At times, a good set of fully custom inserts (arch supports) may be necessary. This doesn’t mean, “any” set of inserts. They must precisely control abnormal motion to be fully effective. Unfortunately, inserts vary greatly and you really have little way of knowing exactly what you’re paying for.

Heel pain can be a very debilitating condition. But like most problems we see, it’s almost always preventable and easily treated by eliminating the cause rather than simply treating the symptoms.

A former reconstructive foot and ankle surgeon and past Clinical Instructor of Medicine at Emory, Dr. Pack practices at MCG in Greensboro. He works with patients who have arthritis and wish to decrease joint symptoms and remain active without medication or surgery. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions). For further information please see www.drloupack.com, drloupack.blogspot.com or contact him directly at 706-454-0040.