Heel Spur Inserts for Plantar Heel Pain
An overweight lady approximately 50 years of age presented to the Heel Clinic reporting chronic heel pain from plantar fasciitis and requesting heel spur inserts to relieve the pain. This lady had been in pain for more than 12 months and was becoming increasingly frustrated as the pain was relentless, and was excruciating each morning. She had been diagnosed with a heel spur in her right foot by her GP but had not found any pain relief from the stretching and rolling that he prescribed. This patient had been informed by the pharmacist that heel spur inserts would help her condition by cushioning the plantar surface of the heel. The heel spur inserts that were available in the pharmacy were generic and off the shelf and were made from soft materials. The patient had been using these inserts for 5 months and while they reduced the sudden impact pain on heel strike, when walking, the condition was not subsiding. The heel pain was still excruciating at times and caused throbbing sensations each afternoon / evening.
This patient reports to the sports podiatrist that she has not been able to enjoy her morning walks that she would partake in with her friends in centennial park, on a daily basis. She would enjoy 45 minutes each day and up to 2 hours on a Sunday – but this had come to a halt. The heel pain was too much and although the heel spur inserts took the edge off the stabbing sensations the throbbing and burning in the plantar heel were unbearable. She would only be able to walk if she hobbled, and this caused stiffness and pain in other areas of her feet and legs. Furthermore, the heel spur inserts were becoming worn and they had compressed quickly. They did not keep shape nor provide arch support and she was reluctant to replace them as they had not helped to reverse the condition.
Assessment of Heel Spur Inserts by Podiatrist
The podiatrist examined the heel spur inserts and asked the patient to stand on top of them on the tiled floor, without shoes or socks. It could be seen that the foot did not receive any “support” but rather “cushioning” which are opposing properties. The feet collapsed and buckled when resting on the soft, compressible material and there was minimal arch support through the medial side of the feet.
The podiatrist was able to carry out a physical assessment of the plantar surface of the heel in order to make an accurate diagnosis of this condition. It was explained to the patient that the cause of her pain was not the plantar heel spur but was a condition known as plantar fasciitis. Plantar Fasciitis is commonly mistaken for heel spur syndrome, and it should be noted that heel spurs can often exist innocently, without the patient feeling any discomfort. When a patient complains of heel spur syndrome, this should be interpreted as plantar fasciitis. Under ultrasound imaging it is quite possible to see thickening and inflammatory change of the plantar fascia surrounding the heel spur. Therefore, heel spur inserts should be named plantar fasciitis inserts. It was explained to the patient that treatment should be directed at the plantar fascia and not the heel spur.
Heel Spur Inserts Vs Plantar Fasciitis Inserts
At the heel clinic, the podiatrists prescribe prescription orthotics to treat plantar fasciitis, and it is explained to the patient that these are not heel spur inserts but instead plantar fasciitis inserts. The orthotics are designed using 3D scanners and are made using 3D printers. The accuracy of these inserts is crucial and any anomalies in the shape or measurements will affect the benefits of the inserts. Unlike heel spur inserts, the plantar fasciitis inserts are made using firm materials that keep shape and support the fascia throughout the entire sole of the foot. This reduces the pulling sensation of the plantar fascia on the heel and the condition reverses naturally, without injections or medication.
Orthotics made with traditional arch support theory can increase the symptoms of plantar fasciitis and can prolong the condition, due to the fact that they press upwards against the fascia in an attempt to push it higher than its natural resting position. Heel spur inserts and other shoe liners made from soft materials provide cushioning and therefore create instability which is counter to treatment. The foot must be stabilised using firm materials.
Plantar Fasciitis Treatment Without Heel Spur Inserts
This patient was made aware of the difference between soft heel spur inserts and firm prescription altho orthotics and was successfully treated with the latter. However, it should be understood that treatment of plantar fasciitis is multifactorial and the patient was also required to perform stretches on a daily basis. She was also given solid footwear advice and was instructed not to walk in her bare feet.