Many of us tend to think of spurs as being those old, pointed metal devices worn by cowboys on their heels in order to persuade (if that’s the right word) their horses into picking up the pace. You probably don’t think about it often, but many people are walking around today with intrinsic spurs coming off their actual heel bones! Unlike cowboy spurs, these spurs are made of bone and are actually a forward projection of the lower aspect of the “calcaneus” or heel bone. They play a unique and interesting role in the etiology of heel pain.
Much of the heel pain seen by podiatrists today is due to “plantar fasciitis” which is an inflammation of the connective tissue band running from the bottom of your heel to the base of your toes. Sitting just above and adjacent to the plantar fascia are numerous muscles which help the foot to maneuver. These structures are all closely attached to a small area on that front bottom part of the heel bone. As you might imagine, this creates a great amount of tension in that part of the heel, and over time the constant pulling of those soft tissues on the bone can lead to the development of a bony protrusion towards the direction of pull. Age, genetics, biomechanics, and other factors may all influence this phenomenon.
If you were to look at a foot model or an X-ray of a heel spur, you might be fairly surprised as they can get up to half an inch long and appear sharp-almost like a hook protruding from the heel. Actually, much of the pain involved is NOT due to the spur but rather to the inflamed soft tissues in the area. Thus, more often than not, treatment is aimed at relieving tension and irritation in the soft tissues as well as evaluating them for tears and other pathology.
Whether a spur is present or not, you should definitely visit your podiatrist if you’re having significant heel pain. He or she can evaluate it clinically and then order an X-ray or other test to see if spurring is actually present. A spur may in fact be causing the pain if it gets large enough and starts to compress on nerves in the area. The doctor can also evaluate the nature of the spur, which in some cases may help to rule out hormonal issues, arthritic disorders, and other systemic conditions. Furthermore, imaging and other diagnostic measures can help to indicate whether something else entirely-such as a fracture-is causing the pain.
Though often an incidental finding, heel spurs in certain cases can become critical to the evaluation and treatment of heel irritation. They may be the key to relief.
As the Fall sports season gets underway, many fans and athletes are excited for another year of events and competition. Though no one can predict exactly what will happen this year, athletic injuries are always a given. One of the most common injuries associated with football players is referred to as “Turf toe”. While this may sound like a relatively benign issue, it can actually prove devastating to athletes, teams, and even non-athletes who encounter this condition. Even NFL stars such as Deion Sanders, Darren McFadden, and LaDainian Tomlinson have missed significant playing time because of this injury.
Turf toe basically results from hyperextension or an excessive upward bending of the first toe at the ball of the foot. There’s a major joint in this area with many important structures which can each be easily damaged in such an injury. This scenario commonly results when an individual’s foot-with the heel raised and the forefoot about to push off-receives a direct force down and through the ball of the foot. The end result is usually pain, swelling, and stiffness of the joint which, of course, depends on the extent of the injury.
The phrase “turf toe” has actually become somewhat of a junk term to refer to any traumatic injury of the big toe joint. In reality, it is a unique entity which separates it from other similar issues. For example, “sand toe” is a separate injury involving hyper-flexion or a downward over-bending of the big toe which is often seen in volleyball players. Turf toe actually ranks third in frequency behind knee and ankle injuries in football players, and though not as common as ankle injuries, it results in more missed playing time. The issue has become more prevalent over the years for several reasons. First, many sporting events now take place on synthetic surfaces like AstroTurf which have more friction and don’t allow the toes to adapt as well to various forces. Secondly, whereas older athletic cleats had a metal plate in the forefoot to limit excessive bending, newer models are generally more flexible (for speed) and less shock-absorbing.
Podiatrists typically address turf toe cases by first assessing the symptoms and possibly ordering and x-ray or an MRI to determine the extent of the damage. Based on these findings, they can classify the injury, give an accurate prognosis, and implement proper treatment. Mild cases may involve simple taping and plate splinting of the toe with return to activity in a few days. More serious cases may require the use of crutches or casting and may necessitate up to six weeks of missed playing time. Very severe cases might warrant a surgical approach to repair soft tissue structures, remove bony fragments, or provide other corrective measures. It all depends on the particular case.
Whether in sports or everyday life, traumatic injuries are certainly not fun. Thanks, however, to proper treatment and our bodies’ healing abilities, they can often be managed effectively.
You wake up in the morning ready for the start of a new day with new possibilities. Turning over, you step out of bed groggily, ready to get things started when “Ouch!”- a sharp pain ripples through your heel, jolting you awake more quickly than you were expecting. The pain dissipates with a few steps only to return and haunt you later in the day. These signs are a classic description of a very common condition known as “plantar fasciitis” which in turn is probably the most well-known cause of heel pain. However, there are MANY causes of heel pain out there and distinguishing between the possibilities can be a tricky task.
“Plantar fasciitis”-the flagship example noted above-is a mechanical etiology of heel pain resulting when there is inflammation along the plantar fascia which is a fibrous band of connective tissue running along the length of the sole of the foot. Other “mechanical” causes might include a wearing away of the fat pad beneath the heel, an irritated Achilles tendon, bony outgrowths from the heel bone, growth plate disturbances, and other issues.
Certain systemic conditions can also cause joint problems which may result in heel pain. These include a wide variety of conditions such as kidney problems, Rheumatoid arthritis, fibromyalgia, gastro-intestinal disorders, and many others. Other potential causes include nerve entrapments, stress fractures, infections, blood-flow problems, tendon ruptures and even tumors.
Needless to say, a sore heel can be an annoying and enigmatic problem. Your podiatrist is an expert at distinguishing between all the potential underlying causes and treatments. He or she can perform a wide variety of revealing diagnostic exams-from the simple to the more complex-to clarify the root cause of the pain in your particular case. Since some of these causes are serious while others are more benign, that information should be valuable to you!
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