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Heel Spurs - and Shoes That Can Help

It seems to happen suddenly. One morning you wake up and that first step out of bed feels as if there’s a drawing pin right inside your heel. It seems to settle down after a few hours, but again the next morning – or even when you stand after a few hours rest – the pain recurs.

Time and gravity have an influence on this problem. The most usual sufferer is a person of middle years who has suddenly engaged in more strenuous walking than normal, or an adult of any age who has subjected their feet to unusual stress or strain. Experts often use the terms plantar fasciitis or periostitis of the calcaneus to describe the malady, but many folk use the common expression “heel spurs”.

There are many explanations for the cause of the pain and the underlying problems which cause it, but the most usual is that the plantar fascia ligaments which stretch under the foot have been torn or damaged in some way where they connect to the base of the heel and have become sore and inflamed. Nature tries to heal the damage during rest, but then the foot is used, the ligaments are stretched again and the pain recurs. If the problem is not treated early, the damaged tissue can actually calcify, with the characteristics of bone. The relationship of the ligaments to the bones of the foot is shown in the drawing of foot anatomy. We can see that the ligaments run below the bones, and we can imagine how the ligaments can become over-stretched – particularly if the natural arches of the feet are stressed by too much work, walk or weight.

foot diagram

Sufferers who feel the pain in their heel often put pads under the heels, but this can be counter-productive because the pads lift the heels and stretch those troubled ligaments even more. More stretch, more damage, more pain.

There are many different treatments for plantar fasciitis. Most start with the simple prescription, REST. The rationale of this approach is that since the problem is associated with excessive strain on the ligaments, it may heal itself if the foot is freed of stress strain and work.

Another feature of successful treatment of plantar fasciitis is that it should be timely. If the condition is recognised early and appropriate treatment adopted within a matter of weeks, the recovery can be rapid and complete. If the problem persists, if it is badly treated, or untreated the constant trauma at the base of the ligaments is said to lead sometimes to calcification and actual spurs of bone inside the heel.

A favourite form of treatment for the problem is through the use of orthoses, or orthotics: supports which lift the arches of the feet and take tension off the ligaments so they can heal. Orthotics also can incorporate cupping in the heels which helps avoid placing pressure on the central parts of the heels and reduces the pain.

There are many off-the-shelf orthotics and supports available, generally from pharmacies or sports stores which can often produce results which seem miraculous. Typical off-the-shelf supports are the Australian made Solemates which can be placed inside shoes, even under the removable innersoles in some shoes. At Gilmour’s Pty Ltd excellent results have been obtained by the use of Solemates underneath the standard removable innersoles in walking shoes.

Solemates

These orthotics come in a limited size range only and may not be ideal for all feet, but they are cheap and often remarkably effective. The great advantage of the Solemates is that they are designed to fit into many different shoes. Another off-the-shelf- orthotic widely used in Australia is the Prothotic, which is softer but bulkier than Solemates.

Prothotic

For the best orthotics the services of podiatrists, pedorthists or orthotists are required. Podiatrists can organise to take a cast of the feet and have orthotics prescribed to match the foot exactly. These are more expensive, but can be fitted exactly to the feet.

Other much used therapies for plantar fasciitis involve the use of pain reducing medication and injections, ranging from doses of aspirin or vitamin C to cortisone injections into the heels and/or to the use of magnetic innersoles. Anti-inflammatory medications, ice packs and taping of the feet also are employed sometimes to good effect.

Some health professionals who deal with plantar fascia problems also highlight the value of exercise – so that the muscles which maintain the arches in the feet can be strengthened and the arches restored. A favoured exercise involves stretching the calf muscles, so that the feet are able to flex upwards at the toes easily and there is less strain on the plantar fascia ligaments. If the calf muscles can stretch, it is argued that the plantar ligaments will not have to stretch so much. The logic of this is related to the relative lengths of the ligaments in the feet and the calves; a very small proportionate increase in the length and “stretch” of the calf muscles is needed to allow the foot to arc upwards, but a much larger proportionate increase in the “stretch” of the underfeet ligaments is required if they are providing the stretch.

Some therapists have reported success with night splints which are worn while asleep to hold the feet bent upwards in a manner which gently stretches the ligaments in the calf. Pictured is a typical night splint.

Night Splint

There are strong arguments for maintaining fitness and muscle tone in the feet as in the rest of the body, but some experts in the field believe exercise and fitness are more preventative measures than treatment after the pain has developed. The same arguments are applied to matters of weight. But while there are many sufferers of plantar fasciitis who are overweight, and those carrying excess kilograms are more likely to suffer the problem than others, there are also many sufferers whose body weight and shape are considered ideal

Over many years in the shoe business, helping persons with plantar fasciitis, the specialist shoe fitters at Gilmour's Pty Ltd have found that many types of footwear can help enormously in treating the problem.

Such shoes feature low heels, firm support for the heels to hold the feet into the heels of the shoes, firm soles, built up arches and/or room to insert arch supports, heel cups, cushioned and shock absorbing soles. Most fitters handling feet with plantar fascia problems recommend lace up shoes which fit high on the big bones of the feet and provide angular support holding the feet into the heels of the shoes.

To ensure a snug fit, lace up shoes with padded tongues and heels and top-lines are also favoured because they can be laced more firmly. As an alternative to lace-ups , there are increasing numbers of good fitting orthopaedic and supporting shoes using Velcro fasteners.

Shoe styles recommended by fitters at Gilmours Shoes are the Rockport “World Tour”, available in both women’s and men’s sizes or the Soft Spots Supremes “Trek” for women.


Rockport “World Tour”	Soft Spots “Trek”

Probably the single most popular women’s shoe in Australia for wearing with orthotics is the Hush Puppies “Classic Walker”. It is very competitively priced. It is a very deep shoe with a removable innersole and heavily padded tongue and top-line.

Hush Puppies Walker

Hush Puppies Classic Walker

All these shoes are low heel lace-ups with very well cushioned soles, contoured innersoles that provide some arch support and some cupping for the heels. The innersoles can also be removed to make way for prescription orthoses, or so that off-the-shelf arch supports like Solemates can be inserted below the innersole. They also have padded tongues and top-lines so that the high lacing can be drawn tight to hold the feet firmly into the heels of the shoes. The “World Tour” has a double density urethane sole, hard on the bottom layer but soft under the foot, and this enhances its shock absorption capacity while giving some stiffness to aid walking.

Other shoes which have been particularly effective for women sufferers of plantar fasciitis include Soft Spots “Bonnie Lite” and Ecco “Soft”.


Soft Spots “Bonnie”	Ecco “Soft”

These shoes are also low heeled lace-ups with cushioned, shock absorbing soles. They do not have removable innersoles, but compensate by having inbuilt arch supports and exceptional fitting characteristics. Again, their designs are characterised by having lacing which ties very high on the arches of the feet, holding the feet on the big bones which can take the strain. Soft Spots also make a Velcro fastener running mate for Bonnie. It is called “Angie”.

Angie

Soft Spots “Angie”

Sufferers of plantar fasciitis, who dread those first steps after rest, become sensitised to another of the great issues in treating their problem – the need to have some footwear which they can use as slippers as soon as they get out of bed. Most sufferers recognise that normal slippers provide little support for the arches and can allow damage to the feet in those first steps in the morning. Many customers of Gilmours have found clogs or sandals with contoured footbeds to be effective alternatives to normal slippers.

Typical are Fly Flot clogs or NAOT footbed scuffs and sandals.


Fly Flot Clogs	NAOT “Santa Barbara”

The NAOT Santa Barbara sandal is almost an orthotic with straps. It has an inbuilt arch support and a cupped heel. Another style is also available with a strap around the heel.

Because many women who use orthotics are restricted to high cut lace up shoes and orthopaedic shoes, they yearn for something more dressy and feminine – particularly in summer.

Sturdy lace up shoes cope best with orthotics, taking the additional strains involved, and holding the orthotics in place; however, it is possible to obtain some sandals which can cope with orthoses for occasional, lighter wear. The New Zealand shoemaker Kumfs has answered the pleas of women with orthoses by producing a range of depth shoes and sandals.

One of the most popular of the Kumfs sandals is the style “Deanna”.
Kumfs Deanna

Kumfs “Deanna”

“Deanna” has sound orthopaedic credentials. It has a low heel, with a cushioned, shock-absorbing sole and heel, and a padded top-line, but instead of a lace it holds the big bones of the foot into the heel by a strap placed exactly where the foot can best take the pressure. It comes with a custom arch support which can be removed in favour of a prescription orthotic if necessary. Gilmour's Pty Ltd fitters regard this shoe as one of great significance

Few manufacturers anywhere in the world have been able to produce a sandal which looks so good, fits so many feet and copes with such a wide range of orthotics. In addition to these shoes, difficult and chronic cases of plantar fasciitis may require more traditional orthopaedic footwear, such as the extra depth shoes or sandals made by the Australian shoemaker Gadean (available through Gilmour’s head office at Glen Huntly) and the international brand Soft Spots (available at all Gilmour’s shops).
Classic orthopaedic shoes such as these are available in a very large number of size and width combinations and can be specially ordered even in odd, mis-matched pairs.


Gadean Depth Shoe	Gadean Depth Sandal

Soft Spots “Grand Prix”	Soft Spots “Daytona”

In many decades of experience in fittings shoes, Gilmour's Pty Ltd staff have learned that good shoes, sound fitting, and appropriate use of supports and orthotics can provide great benefit.

However, it is important to remember that pain is nature’s warning signal, and if it persists or worsens, a doctor should be consulted

In Summary:

Plantar Fasciitis can be treated with great success, and in a matter of weeks, if it is treated early. But treatment takes longer and the outcome is less certain if left too long.
The condition rarely gets better by itself – some intervention and treatment is advisable.
A key to treatment is to provide support under the arches of the feet so that the tension on the ligaments is reduced and they can heal themselves.
Exercise of the feet can help, along with stretching of the calf muscles to allow the feet to arc upwards without too much stretch on the plantar fascia ligaments.
Never try to treat the problem by placing extra padding under the heel where it hurts. That merely lifts the heel, stretches the ligaments further and exacerbates the problem.
Be wary of going barefoot. Use arch supporting sandals or scuffs instead of slippers.
Low heel, lace-up or high cut footwear is always better for feet than high heel low cut shoes.
Shoes that hold the feet well into the heel are to be preferred – and particularly shoes that hold on to those big bones high up the foot
Plantar Fasciitis is a health problem that is closely linked to levels of general fitness and weight.