Can Surgery Help with Heel Spurs? Solutions for Foot Pain

Q: Can Surgery Help with Heel Spurs? Solutions for Foot Pain

Dear readers： The exact cause of heel spurs is not very clear. <br>Recent studies suggest that it is a manifestation of degeneration, possibly a skeletal response to counteract the stress experienced during standing or walking, aimed at preventing microfractures. <br>There is no

Can surgery be performed?

How can I address bone spurs on the soles of my feet? Is surgery an option?

Xiao Lanlan, 40~49 year old female. Ask Date: 2008/09/29

Dr. Chen Xingyuan reply Orthopedics

Dear readers: The exact cause of heel spurs is not very clear.
Recent studies suggest that it is a manifestation of degeneration, possibly a skeletal response to counteract the stress experienced during standing or walking, aimed at preventing microfractures.
There is no absolute correlation between the occurrence of bone spurs and heel pain.
Many individuals with prominent bone spurs do not exhibit any symptoms.
The calcaneal bone spurs seen on X-rays typically do not cause pain because, according to research, the location of the calcaneal spur is at the origin of the short flexor muscles of the toes, rather than at the attachment site of the plantar fascia, and surgical removal is generally not necessary.
The plantar fascia is a strong band of tissue located on the bottom of the foot, connecting the bottom of the heel bone to the bones of the midfoot.
Prolonged standing or walking can cause the area where the bone meets the soft tissue to endure long-term pressure and tension, leading to injury or inflammation known as plantar fasciitis.
If an X-ray is performed, about 80% of patients will show the presence of bone spurs.
"Heel spurs," "heel pain," or "plantar fasciitis" are essentially different terms for the same condition.
Plantar fasciitis is common among individuals over 40 years old whose occupations require prolonged standing or walking, such as teachers, farmers, or those in the food service industry.
Occasionally, young athletes may also experience foot pain due to excessive training or improper training techniques.
The primary mechanism involves repetitive long-term tension on the plantar fascia, resulting in cumulative damage that leads to inflammation and degeneration.
Most cases of plantar fasciitis can be managed with conservative treatment, such as resting more, reducing walking or standing, taking oral pain relievers and anti-inflammatory medications, massaging and stretching the plantar muscles, and strengthening exercises to reduce the risk of recurrence.
Additionally, selecting appropriate footwear or using various heel pads to distribute heel pressure (available at medical supply stores) is recommended.
Professional athletes may use athletic tape during sports to enhance arch support, which can also alleviate symptoms.
If these measures are ineffective, physical therapy, such as ultrasound or deep heat therapy, may be considered.
If there is still no improvement, local corticosteroid injections can be considered, but it is important to note that each injection should be spaced one to two weeks apart and not exceed three injections, while avoiding the fat pad of the foot to prevent adverse effects.
Some individuals may also use shock wave therapy or low-dose radiation for treatment.
Generally, the likelihood of requiring surgical intervention for heel pain is low, with literature reporting that about 10% of cases necessitate surgery.
If conservative treatment over three to six months proves ineffective, surgery may be indicated, typically involving the removal of a portion of the plantar fascia, with the vast majority of patients experiencing satisfactory improvement.
Plantar fasciitis is a common issue among various professions that require prolonged standing and walking.
However, with appropriate treatment and rest, the vast majority of patients can achieve excellent outcomes.
Calcaneal spurs are often just incidental findings and usually do not cause pain, and surgical removal is generally unnecessary.
Wishing you health and safety! Sincerely, Dr.
Chen.

Reply Date: 2008/09/29

More Info

Heel spurs, or calcaneal spurs, are bony protrusions that form on the underside of the heel bone (calcaneus) and are often associated with conditions like plantar fasciitis. They can cause significant foot pain, particularly when standing or walking. The question of whether surgery is necessary for heel spurs is a common concern among patients experiencing chronic foot pain.

Non-Surgical Treatment Options
Before considering surgery, it's essential to explore non-surgical treatment options, as many patients find relief through conservative measures. Here are some commonly recommended approaches:
1. Footwear Modifications: Wearing supportive shoes with adequate cushioning can help alleviate pressure on the heel. Shoes with a wide toe box and good arch support are particularly beneficial. Custom orthotics or shoe inserts can also provide additional support and help redistribute pressure away from the heel.

2. Physical Therapy: Engaging in physical therapy can be highly effective. A physical therapist can design a personalized exercise program that includes stretching and strengthening exercises for the foot and lower leg. This can help improve flexibility, reduce tension in the plantar fascia, and strengthen the muscles that support the arch of the foot.

3. Anti-Inflammatory Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation associated with heel spurs.

4. Corticosteroid Injections: In some cases, corticosteroid injections may be administered to reduce inflammation and provide temporary relief from pain. However, these should be used judiciously, as repeated injections can have adverse effects on the surrounding tissues.

5. Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses sound waves to promote healing in the affected area. Some studies suggest that ESWT can be effective in reducing pain associated with heel spurs.

6. Weight Management: For individuals who are overweight, losing weight can significantly reduce the stress on the feet and alleviate pain.

When is Surgery Necessary?
If conservative treatments fail to provide relief after several months, surgery may be considered. Surgical options typically include:
1. Heel Spur Surgery: This procedure involves removing the heel spur and any inflamed tissue around it. The goal is to relieve pressure and pain.

2. Plantar Fascia Release: In cases where plantar fasciitis is a contributing factor, a surgeon may perform a plantar fascia release, which involves cutting a portion of the plantar fascia to relieve tension.

3. Endoscopic Surgery: This minimally invasive technique allows for the removal of the spur and release of the plantar fascia through small incisions, which can lead to quicker recovery times.

Risks and Considerations
While surgery can be effective, it is not without risks. Potential complications include infection, nerve damage, and the possibility of persistent pain. Additionally, surgery may not guarantee complete relief, and some patients may still experience discomfort post-operatively.

Conclusion
In summary, surgery can be a viable option for treating heel spurs, but it is generally considered a last resort after conservative treatments have been exhausted. Patients should work closely with their healthcare providers to explore all available options and determine the best course of action based on their specific circumstances. If you are experiencing persistent heel pain, it is advisable to consult with a foot and ankle specialist who can provide a comprehensive evaluation and tailor a treatment plan to your needs.

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