Severe rear foot pain that accompanies the first step out of bed in the morning is a sign of plantar fasciitis, a foot condition often accompanied by a heel spur. A heel spur occurs when a calcium deposit forms on the heel bone, causing a bony protrusion. The heel bone is the largest bone in the foot, and absorbs the greatest amount of shock and pressure from walking, running and other activities. The bone is connected to the forefoot by the plantar fascia, a broad band of fibrous tissue located along the bottom surface of the foot. When the plantar fascia is stretched and pulls away from the heel, usually the result of overpronation (flat feet), calcium deposits can form to fill in the gap, causing heel spurs. People with unusually high arches can develop the problem, and women have a significantly higher incidence of heel spurs than men because of the types of footwear they often wear, including high heels. Athletes or dancers who stretch the plantar fascia on a regular basis are also at risk.
According to Dr. Suzanne Belyea, D.P.M., Medical Director of Foot.com, heel spurs themselves do not cause the severe pain. “When people have an over-stretched plantar fascia, it tightens up at night. The first step out of bed pulls it away from the insertion site, and the resulting inflammation of the plantar fascia is what causes the pain. Heel spurs are often present with this condition, but not always”.
Studies have shown that the size of the heel spur does not affect the level of pain, and that treating the inflammation related to the plantar fascia should allow the patient to live pain-free with a heel spur. The key to treating the inflammation is determining the cause of the excessive stretching of the plantar fascia. When the cause is overpronation, an orthotic with rearfoot posting and longitudinal arch support can effectively reduce the problem and allow the condition to heal. Other common treatments include foot stretching exercises, especially first thing in the morning before that first step is taken, weight loss, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic.
Dr. Belyea recommends wearing a shoe that supports the arch as soon as the patient gets out of bed, and even on the way to the shower. “If the initial morning inflammation can be avoided, the entire day will be more comfortable” she says.
If the problem persists, consult your foot doctor.
Run The Planet thanks Foot.com—the “Foot Health Network” dedicated to educating the public about foot health, pain and products—for the permission to reprint the article “Heel spurs: facts and treatment”. Text and illustration copyright © 2001 by Foot.com.