Heel Pain and Bony Spurs

Q:  I believe I have heel spurs. Though I know very little about them, they are very painful, especially in the morning. I have changed from soft, no-heel house slippers, to sturdy, padded walking shoes which seems to help. The condition came on suddenly. I am a senior woman, rather active but never an athlete. I would appreciate an explanation and recommendations. Thanks!

I have had a bone spur for over a year now. I have heard horror stories from my tennis friends regarding surgery, cortisone treatments, etc. What are the preferred methods of treatment for bone spurs? I would appreciate pros and cons of all methods, amount of time that you're laid up, and the success rate.

A:  Heel pain occurs primarily in adults and is more common than I realized, present in about 10% to 15% of the older population. In one study of 100 people with heel pain, the average age was 48, but they ranged in age from 20 to 85.

Many people have the mistaken notion that bony spurs are the cause of heel pain, and that removing the spur will remedy the pain, but there probably is no single cause of heel pain. The "spur" is not actually bone but calcification at the point where the foot fibers insert on the heel bone. Partial tears in the foot fibers or inflammation because of repetitive impact may result in pain.

Treatment can be divided into 3 types: mechanical, medications, surgery.

Dr. Michael Shereff, an orthopedic surgeon who specializes in foot and ankle diseases, believes strongly that an operation should truly be a last resort. He recommends beginning with mechanical methods to reduce the pressure on the heel pad, such as the first reader has done by getting sturdy shoes. Rubber-soled "wedgie" shoes will decrease the impact load of the heel on hard surfaces. Other devices which may be helpful include a firm plastic heel cup and flexible arch supports. He also teaches the patient to do exercises that stretch the heel cord and foot fibers several times a day. Obviously activities that promote the pain may need to be curtailed for some time.

If these measures do not provide relief, then anti-inflammatory medications such as ibuprofen should be tried. Injections into the heel pad are also an option. With conservative treatment alone, there is a good chance for resolution of the symptoms. In the study of 100 patients mentioned above, 82% had complete resolution, 15% had fair results with continued symptoms but no limitation in activity, and only 3 patients had poor outcomes. Those 3 patients all had pain in both heels. Other risks for continued problems included being overweight or having pain for a long period before seeking medical attention. If heel pain continues to be severe after many months of conservative treatment, then there are various surgical techniques that are over 80% effective. If all goes well, the patient will be off their feet for just a few days.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.