Heel Spur Syndrome (HSS) or chronic plantar fasciitis is progression and cycling of inflammation in the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
Back to my previous article on why foot and ankle conditions occur and this is no different. Most common cause of HSS relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing HSS
I see this commonly with wearing nonsupportive footwear on hard, flat surfaces that puts abnormal strain on the plantar fascia. This is very common with patient wearing memory foam or pressure mats at work. Both these create overuse of the foot and leg structures causing strain, inflammation and then HSS.
When first assessing HHS there are many other diagnosis that can mimic this condition; these include plantar fascial tears, nerve compression, stress fracture of the heel, avulsion fracture of the heel spur, CRPS, low back pain just to many a few. Diagnostic imaging studies, such as x-rays or ultrasound, are used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. As seen on this xray; this patient came to the office complaining of flatfoot pain and had no heel pain at all.
The first line of treatment is conservative therapy that includes stretching, supportive shoes and orthotics. Alternatively injections ( Steriod/ Toradol), NSAID, night splints can be options HOWEVER having an accurate diagnosis is imperative. MRI as rarely used unless failure of conservative therapy occurs. Insurance companies scrutinize any orders to assess plantar fasciitis and have rejected more and more over the past years due to cost.
Advance therapy is were patients if failed conservative therapy end up. Over the next several months I will go into all of these option that include and we offer PRP (platelet rich plasma), amniotic injections, stem cells, light therapy and shockwave. Unfortunately insurances do not cover these options but with the rising increase in deductibles these options are much better in cost then formal surgery. Flex spending or HSA can be used.
Surgery is also an option for chronic, difficult and painful cases. These include which I offer; plantar fascial release, decompression of nerves, gastroc release, TENEX just to name a view. Once again I will go into detail regarding each of these in future posts. Nevertheless HHS can be challenging to address and I always ask patient to take an active part in their condition as steriod injections can help but will mask the pain. Eventually they will stop working and more aggressive alternative treatments will be required. Once you start having heel pain