Case Study: Spur on Heel

Case History of Spur on Heel of Left Foot

There was a 42-year-old male who arrived at the heel clinic complaining of a spur on heel of his left foot, which had been troublesome for approximately seventeen weeks. This gentleman described a sharp stabbing pain through the base of his heel which was constantly sore on a day today basis. He described a relentless stubbing sensation and occasional shooting pains from the plantar spur on his heel, and in addition to this he was also experiencing shooting pains around the back of the heel close to the insertion of the Achilles tendon. This gentleman was playing amateur football in the Eastern suburbs league of Sydney when he first began to feel the pain from the spur on heel. He reports to the sports podiatrist that he has always played competitive amateur football for most of his adult life. This would involve football training once a week on Thursday followed by a 90-minute competitive game of field soccer/football on a Sunday. He reports that the pain from the heel spur would be significantly more troublesome on the mornings following his playing football. Generally, he would experience a significant pain in the heel first thing in the morning when waking up and placing his foot onto the floor, walking away from his bedroom. He appeared confused because of the pain after being rested all night, and did not understand why the pain would disappear within the first 30 minutes of his day, after walking. The patient was advised that this is typical of heel pain conditions which normally involve some inflammatory change. The spur on heel of left foot would also become painful after the patient had been seated for a period of 30 minutes or more. He described his inability to walk without hobbling after driving his car. Aside from the spur on his heel, this gentleman reports good foot health and throughout his football career had only experienced minor calf muscle tearing. His calf muscles were reported to be problematic in that he would occasionally feel cramping and a relative tight feeling in both of his calf muscles, particularly following football training and the football match on a weekend. He describes to the podiatrist a fairly committed stretching regime whereby he focuses heavily on hamstrings and calf muscles, and he feels this has enabled him to continue playing football without too many problems. However, the spur on heel of his foot was causing sufficient pain to force him to consider not playing for the rest of the season.

Family Dollar Refers for X-Ray of Spur on Heel

This patient consulted with his family doctor in order to seek treatment for the spur on his heel. The doctor referred the patient for weight bearing x-rays of both feet. The reports were conclusive and it could quite clearly be seen that there were two spurs on the heel of this patient’s left foot. The X-ray clearly identified a posterior heel spur and a large plantar heel spur. The doctor recommended that the patient consult with the sports podiatrist at the heel clinic.

This patient arrived at the heel clinic requesting both a short term and quick solution to keep him active but also a long time solution to treat the spur on heel. Like many patients attending the heel clinic, this particular person made inquiries relating to shock wave therapy and also prescription orthotic therapy.

Spur on Heel

Physical Assessment of Spur on Heel

The podiatrist carried out a routine physical assessment in order to palpate the plantar spur and the posterior spur on heel. Left foot. On physical palpation of the plantar heel spur the patient reported significant pain, similar to that that he would experience when walking. The sports podiatrist informed the patient that while he did in fact demonstrate a large plantar calcaneal spur, this was not the cause of his pain. It was explained to this patient that the cause of the pain is now understood to be inflammatory change within the plantar fascia. This is a condition known as plantar fasciitis. The patient was advised that the diagnosis for his plantar heel pain was plantar fasciitis. He was advised that the spur on heel, underneath his foot, would probably remain in place but would not be of any large concern. The podiatrist explained that treatment is directed at the plantar fascia and this resolves the condition and reverses the pain. The patient was advised that shockwave therapy and orthotics therapy would be considered but that further assessment would be carried out first.

The spur on heel, posterior calcaneus, was also palpated. This also triggered mild pain but not severe pain as with the plantar calcaneal spur. The patient was advised that the pain around the back of his heel was more likely coming from tight calf muscles and a pulling sensation through the Achilles tendon. This condition is known as insertional Achilles tendinosis or insertional Achilles tendinopathy. The podiatrist explained to the patient that shockwave therapy may also be of benefit to this part of the heel.

Biomechanical Assessment

This patient was assessed bio-mechanically on the treadmill inside the heel clinic. His foot function was recorded using digital software on an iPad. The footage was replayed in slow motion and analysed in careful detail. The sports podiatrist was able to determine that this patient demonstrated a classic high arched, Pes Cavus foot type with minimal pronation bilaterally. Limited range of motion was observed in both ankles due to restricted range in calf muscles. Early heel lift was observed due to shortening and tightening of said calf muscles and the achilles tendons. In a weight bearing position the podiatrist measured both medial arch heights which exceeded 33 mm, left and right side. The podiatrist explained to the patient that the possible cause of the spur on heel, both plantar and posterior, was a bio mechanical anomaly in the calf muscles and Achilles tendons.

Treatment for Spur on Heel – Plantar

The sports podiatrist explained to the patient that in order to treat the plantar spur on heel, or moreover the plantar fasciitis, he would be applying treatments to unload the fascia. As a short-term and long term benefit, the podiatrist agreed to apply shockwave therapy to the base of the heel and also applied strapping to support and unload the plantar fascia, which would reduce the pulling sensation on the plantar spur on heel of Left foot. As a longer-term solution that podiatrist organised touch and hold prescription orthotics that would support the plants fascia and reduce the pulling sensation on the base of the heel. The orthotics were carefully designed not to represent traditional arch supports which can lead to an increase in pressure on the plantar fascia, which prolongs the plantar heel pain.

It was explained to the patient that one of the main parts of his treatment would be to perform stretches three times per day. Calf muscle stretches would be imperative and of the utmost importance in order to rectify the plantar and posterior heel pain. This would correct the early heel lift and restore more normal bio-mechanics through the ankle and rear foot.

The podiatrist captured 3D scans of the left and right foot in order to prepare the prescription orthotics.

The patient received one shockwave therapy session at his first appointment and returned one week later for a second session and to be fitted with his prescription inserts. To his surprise, the pain from the plant spur on heel – left foot, felt significantly better within one week. Naturally, the early morning pain and pain after being seated was still present, however it had reduced significantly.

With the strapping in place the patient was able to play football. Once he was warmed up the pain was mild and he was able to continue playing. He continued to perform regular stretches and would also receive massage through the lower leg and hamstrings. This patient returned to the heel clinic once every week for shockwave therapy and the reapplication of strapping. He reported that his prescription inserts were extremely comfortable and he was able to wear them on a day today basis. The inserts were used inside his football boots and tolerated well, without blisters or skin irritation . The specific modifications to the heel of the orthotics gave great comfort for the spur on heel and provided stability and comfort for this section of the foot.

More information of the orthotics design at the Heel Clinic here:

  1. TOUCH AND HOLD– without traditional “arch support” – see above.
  2. ILA BAR– (Inner Longitudinal Arch Bar) – The clinic manufactures inserts that have a reinforcement bar which can’t be seen from the top but strengthens the arch (without pushing upwards and against it). This takes away tension and strain from the plantar fascia, allowing it to heal.
  3. MATERIAL – SOFT AND FIRM– The perfect combination. Soft for comfort and cushioning, firm for support. (Many patients have tried orthotics before attending the Heel Clinic and have described them as feeling “too hard”. This is due to the orthotics being too high in that particular spot. See point 1 above. Arch shape is crucial).
  4. CORRECTED CALCANEAL ANGLE(heel position) – After assessing your heel, the practitioner will arrange your required heel position / angle based on vertical alignment.
  5. SLIMLINE– Made using the latest 3D scanners (and 3D printers ) the clinic offers streamline, lightweight orthotics that will comfortably fit into fashion shoes.

Please note the information contained in this case study is not medical / podiatrist advice. It relates to one particular patient. Please consult with a podiatrist if you have a spur on heel or feel pain from plantar fasciitis / Achilles Tendonitis.

Article written by Karl Lockett – podiatrist.