I am a big fan of random questions! This is a helpful trait to have if you are a parent of young children and/or a physician. As a parent, random questions are thrown my way several times a day! As a physician it happens all the time, too, whether by text, email or in person. As a result, the Random Question section of my blog was born!
For example, just the other day, my dad texted me from New Jersey with this question: Can I ice a heel spur?
First I needed to figure out more about this heel pain my dad was having.
Further inquiry revealed that the heel pain in question is located on the bottom of the heel. It had gradually gotten worse after my dad refereed five soccer tournament games the previous weekend. Yep, he is an active guy! The pain is at its worst first thing in the morning when he gets out of bed, and gets better as he walks around or when he sits down. In fact, any time he gets up from sitting the pain recurs. In summary, this is a typical picture of heel pain in adults. And the most common cause of heel pain in adults is plantar fasciitis, not a heel spur.
The plantar fascia is a band of tough tissue that runs along the bottom of your foot. Its function is to support the foot, especially during the weight-bearing phase of walking. Microscopic degenerative tears in the plantar fascia where it originates on the heel bone (the calcaneus) trigger a chronic reaction in the fascia that is the cause of pain. Thus, plantar fasciitis pain is felt directly over the medial calcaneal tuberosity where the plantar fascia attaches to the calcaneus (the heel bone). Just above this attachment is a common location where the proverbial “heel spur” forms.
A heel spur (or any bone spur for that matter) is an osteophyte: a bony outgrowth into a tendon or joint. The one that forms in the heel develops in the origin of the flexor brevis muscle; and 50% of them occur in people with plantar fasciitis. On the flip side, many people have a heel spur that is not symptomatic.
So why is plantar fasciitis pain worse in the morning? When you are sleeping, your foot is mostly plantar-flexed (the toe is pointed) and the plantar fascia is in a shortened (tight) position. When you wake up and try to walk, or when you arise from sitting for a while and try to walk, the tight plantar fascia sustains more microscopic tears, which leads to more of that chronic reaction in the fascia, which in turn leads to more pain. This cycle can become vicious and chronic very quickly!
The vast majority of people with plantar fasciitis are successfully treated with non-operative measures, but it can take six to 12 months or more of consistent treatment for symptom resolution. The two most important treatment interventions are stretching and orthotics. Consistently stretching the plantar fascia before you get up to walk interrupts the vicious cycle before more microtears occur in the fascia. But it only works if you do it every single time you get up. A cushioning heel pad in the shoe or switching to shoes with a shock-absorbing heel can often alleviate pain. A night splint to keep the plantar fascia on stretch can be very helpful too; since Achilles tendon/calf muscle tightness can contribute to plantar fasciitis, this splint keeps those structures on stretch while you are sleeping as well. Some people benefit from a home stretching program directed by a physical therapist. In rare cases surgical treatment of the heel spur or plantar fascia may be necessary.
Plantar fasciitis is an extremely frustrating injury for an active person at any level of activity. Here are a few tips to help you avoid it:
- Wear well-fitted shoes with shock-absorbent soles and rigid shank (sole). You should not wear shoes with excessive wear on the heels or soles.
- Choose footwear that are appropriate to your type of physical activity. For example, running shoes are very different than cycling or soccer shoes!
- Always make time to properly warm up before engaging in physical activity.
- Finally, pace yourself during physical activity. Be aware of your body’s signs of fatigue and stress and more importantly, listen and respond to them!
Random Question Answer: Yes, you can ice a heel spur! It will help calm down the inflammation in the area of a heel spur and simultaneously do the same for plantar fasciitis.