Question:
I have multiple heel spurs that are very painful and swollen. What can be done for these? Can they be removed without surgery?

Answer:
The most common cause of deep pain on the bottom surface of the heel, is plantar fasciitis (inflammation of the plantar fascia), which results from inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. A heel spur is a point of excess bone growth on the heel that forms as a result of chronic irritation and inflammation of the plantar fascia. The spur itself is not the source of pain.

The goal of treatment is to heal the tears and decrease inflammation, as well as prevent the condition from recurring. Supporting the arch with a well-fitted arch support, or orthotic, may help reduce the pressure on the plantar fascia. A special type of shoe insert, called a heel cup, can reduce the pressure on the sore area and add padding to the heel.

Anti-inflammatory medications and, sometimes, cortisone injections may be used to decrease the inflammation in the fascia and reduce pain. But multiple injections are not recommended because they can weaken and rupture your plantar fascia, as well as shrink the fat pad covering your heel bone.

If conservative treatment fails, endoscopic plantar fasciotomy is the newest surgical method for heel pain and for the correction of plantar fasciitis. The new procedure, performed on an outpatient basis under a local anesthetic, utilizes specially designed instruments and fibro-optics that allow the surgeon to directly visualize the structures of the foot on a video screen through two small incisions in the foot. Because the procedure is minimally invasive, patients have a shorter recovery period and a faster return to normal activity.

Used in Europe for more than 15 years, extracorporeal shockwave therapy is now available in the U.S. "Extracorporeal" means "outside of the body," and refers to this non-invasive surgical procedure in which strong sound waves are directed at the area of heel pain. The device used is similar to that currently used in non-surgical treatment of kidney stones.

The treatment takes about 30 minutes and is performed under local anesthesia. Strong sound waves penetrate the heel area and stimulate a healing response by the body. It is an outpatient procedure and does not require an overnight stay in the hospital.

To help prevent heel pain, doctors suggest these tips:

• Buy shoes that fit well, have shock-absorbent soles, rigid shanks, and some extra padding in the heels.
• Avoid going barefoot or in your sock feet, and do not wear flat, slide-on house slippers.
• Trim down, if you are overweight.
• Pace yourself in exercise and athletic activities. Warm up thoroughly, including stretching, before exercising. Concentrate on calf stretches, since tight calf muscles can tighten the fibrous tissue that attaches to the heel and contributes to heel pain.