The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop.

The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rearfoot, especially while standing or walking. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches (pes cavus) can also develop heel spurs.

The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal.

Heel spurs and plantar fascitis are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding re-injuring the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the proper fitting of shoes are all-important measures to decrease this common source of foot pain. Modification of footwear includes shoes with a raised heel and better arch support. Shoe orthotics recommended by a healthcare professional are often very helpful in conjunction with exercises to increase strength of the foot muscles and arch. The orthotic prevents excess pronation and lengthening of the plantar fascia and continued tearing of this structure.

To aid in this reduction of inflammation, applying ice for 10-15 minutes after activities and use of anti-inflammatory medication can be helpful. Physical therapy can be beneficial with the use of heat modalities, such as ultrasound that creates a deep heat and reduces inflammation. If the pain caused by inflammation is constant, keeping the foot raised above the heart and/or compressed by wrapping with an ace bandage will help.

Corticosteroid injections are also frequently used to reduce pain and inflammation. Taping can help speed the healing process by protecting the fascia from reinjury, especially during stretching and walking.

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide relief of pain and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. Depending on the presence of excess bony build up, the procedure may or may not include removal of heel spurs. Similar to other surgical interventions, there are various modifications and surgical enhancements regarding surgery of the heel.

Endoscopic surgery -- endo: meaning the end of, and scopic: meaning to look at -- is an instrument that looks at the end of a closed space. When endoscopic surgery is used on the foot, it usually deals with the plantar fascia -- plantar: meaning the bottom of, and fascia: the thick ligament that runs from the back of the heel to the front of the foot.

The plantar fascia is a commonly inflamed structure associated with heel spurs. When an endoscopic procedure is performed to lengthen or cut the plantar fascia, a portal of entry into the foot from the side is created, either medial (inside) or lateral (outside), to expose the plantar fascia. This procedure involves a much smaller incision than traditional surgeries and is much more precise. The post-operative period of time in healing is also reduced, as well as the pain.

Plantar fasciotomy via endoscopic technique is a very effective procedure when all other conservative measures, such as: arch supports, orthotics, padding, medications, physical therapy, etc., have been used. This procedure can usually be performed under local block anesthesia and rarely is general anesthetic necessary. Recovery time is usually in the range of three weeks. Most surgeons use a post-operative walking boot and immediate ambulation is usually possible.