Do I have heel spurs? And do I need surgery? “Probably not” may very well be the answer to both questions. “Heel spurs don’t usually cause pain,” says Charles E. Graham, MD, clinical associate professor of surgery (orthopedics) at the University of Texas Health Science Center at Dallas, and a specialist in foot and ankle surgery. A number of conditions can cause heel pain, including nerve entrapment, bursitis, arthritis, and Reiter’s syndrome; and stress fractures are a frequently overlooked possibility. “The muscle that attaches to the heel holds together better than the bone. When stressed, the muscle pulls the bone, resulting in a stress fracture.” Dr. Graham and his colleagues want to disabuse the public of the notion that heel pain means heel spurs. “It is very important that a patient get a second opinion before consenting to heel spur surgery,” says Dr. Graham.
A jogger and a victim of a stress fracture himself, Dr. Graham found that many patients whose heel pain had been attributed to bone spurs did not actually have any. Bone scans revealed that some of these individuals had hot spots–which suggested fractures–on the painful heel, but not on the unaffected side. Eventually, Dr. Graham devised a method for demonstrating the stress fracture on an X-ray, eliminating the need for a bone scan. When heel spurs were present, they were not related in any consistent way to pain. Dr. Graham’s studies, which he has been conducting since 1983, involved more than 400 patients.(*)
Most stress fractures are related to sports, particularly jogging, aerobics, and similar exercise. The majority of the other fractures can be traced to a weight gain of 9-14 kg (20-30 lb) over a 5-6 month period. Other causes include minor injuries sustained while climbing or standing on narrow-rung ladders or those incurred by using a foot to push a shovel into the ground.
Dr. Graham has formulated a treatment program that involves a moderate amount of exercise and a plantar fascial stretch: Put your hands on a wall and lean against them. Place the uninjured foot on the floor in front of you and the injured foot behind so that its heel does not touch the floor and then stretch or bounce gently. He also recommends walking 2 miles per day to strengthen the surrounding bones and muscles. “Swimming and cycling are also beneficial,” he adds. The pain will probably get worse until the muscle stretches out. Dr. Graham says that he continued jogging, though at a less rigorous pace, during his own recuperation.
In the follow-up to one of his studies, 50-60% of the joggers who returned questionnaires had healed within 3 months and all but eight respondents healed within the year. “Maybe those who did not heal didn’t adhere to their program,” he speculated.
Dr. Graham is emphatic about the need for thoroughly investigating the causes of heel pain and not automatically assuming that heel spurs are the culprit. He is willing to train interested physicians in his X-ray techniques.