Heel spurs are often associated with plantar fasciitis, although some people seem to develop painless heel spurs without any obvious sign of other inflammation.

Plantar fasciitis is inflammation of the plantar fascia, connective tissue in the foot which works in opposition to the better known Achilles tendon. At various times during running and walking these tissues can be subject to loads many times the body’s weight. A pillow of fat underneath the heel cushions this force to a certain extent, but nevertheless the plantar fascia may become inflamed and cracks may even form in it. Plantar fasciitis often makes its presence felt as a sharp, stabbing pain that feels worse when a person stands up after a period of rest.

This inflammation may in turn stimulate the production of new bony material on the calcaneum (heel bone) and thus a bony prominence or bump (a heel spur) is formed. The heel spur may form on the back or underneath of the calcaneum. This in turn may cause further pressure and inflammation, and the degree of discomfort and pain may be enough to impede everyday life. Once matters get to this state, the condition may take over a year to cure, so prevention is highly desirable.

Some risk factors for plantar fasciitis and consequent heel spurs are easier to avoid than others. For example, this problem occurs more often in the middle-aged as pillow of fat under the heel gets thinner and there is really nothing to be done about that. However, there is plenty that can be done about some of the other factors. Regular, low impact exercise is helpful, as is losing excess weight. Warming up properly before exercise is very important and people at risk would be well-advised to avoid going straight from a sedentary lifestyle to one involving sudden, strenuous exercise. Another risk factor is uncorrected pronation (rolling in) of the feet. Pronation is normal, and in fact essential to a good walking gait, but in some people their feet either roll not enough or too much. Over-pronation is a particular problem and leads to a “knock-kneed” posture; this in turn is often a cause of plantar fasciitis.

Once plantar fasciitis has started there are some measures which may be taken to prevent worsening and promote recovery. Anti-inflammatory medicines may be useful for a few days, but may damage the stomach in some people if taken for too long. Rest with the feet raised and the application of ice may be useful to begin with. Special exercises may be prescribed. Surgery to remove the heel spurs is generally considered a last resort as it is sometimes unsuccessful and results in further pain, and in most cases the medical priority is on managing the symptoms.

A good addition to ice and therapeutic exercises is the use of custom orthotics. Orthotics are devices that correct misalignments in the body, and they include many types designed for feet. Orthotic insoles have two great advantages for the treatment of heel spurs. Firstly they provide additional cushioning, which helps alleviate pain; insoles are especially effective at this if they contain at least one layer of high-density foam which acts as a shock absorber. Secondly, by providing proper support to the foot they can correct posture and gait problems that lead to the condition in the first place; this will help prevent it worsening and can often lead to a significant improvement.

Custom orthotics used to be expensive and time-consuming to order, but technology has made them a lot more available and affordable. A new process which allows insoles to be custom designed from three digital images of the foot, which are used to create first a computer model then, through 3D printing, a solid replica of the feet. This is then used as a template to mould insoles from a laminate of EVA foam layers. It makes the ordering process for heel spur orthotics quick and easy and also brings the price down to that of a good set of non-custom inserts.