What is Heel Spur Syndrome?

It is often described as a "stone bruise" by the patient. Pain is usually worse in the morning, especially after the first several steps, or after periods of rest when first standing. As the pain worsens, the heel can hurt after prolonged activity or the day after an especially active day.

What causes it?

Heel Spur Syndrome, or heel pain; pronation causes a mechanical problem involving the structural alignment of the foot. There is a dense inelastic fibrous band of tissue in the bottom of the foot known as the plantar fascia. The plantar fascia inserts into the heel bone and spreads out into the foot. See figure below.

Because of the mechanical misalignment of the foot, excessive tension is placed on this band of tissue, causing inflammation and pain. THE SIZE OR PRESENCE OF THE HEEL SPUR DOES NOT ALWAYS CORRELATE WITH THE AMOUNT OF PAIN. The vast majority of patients with heel pain are cured with orthotics. Some patients need orthotics made from a cast of their feet and others can be cured with an orthotic NOT made from a cast of their feet--both control pronation.

What is Instep Plantar Fasciotomy?

Instep Plantar Fasciotomy is a procedure that has been very successful in the treatment of Heel Spur Syndrome and Plantar Fasciitis in the vast majority of my patients. The procedure was developed to permanently correct chronic heel pain in a less traumatic manner. This technique allows for a quicker recovery and a faster return to normal activity. The procedure involves a
1-2 inch incision on the bottom of the arch which easily allows visualization of the plantar fascia. This is an out-patient surgery usually without general anesthesia as local anesthesia and sedation is usually adequate.

Maybe it will go away!

This is possible, in some patients. However, this is not usually the case. In most cases, the longer the patient waits to seek treatment, the more chronic the condition usually becomes, and thus requires a more lengthy and involved treatment.

Am I a candidate for this surgical procedure?

If you have failed to obtain relief of heel pain symptoms with use of conservative treatment such as orthotics, injections, oral medication or physical therapy, then you may benefit from Instep Plantar Fasciotomy. A complete evaluation and discussion with Dr. Shapiro will help determine your best option. Approximately 95% of patients who have had heel pain for less than one year have complete resolution of their symptoms with orthotic devices.

What Then?

If all your symptoms go away with conservative care then surgery will not be necessary. If, however, pain and discomfort are still present after conservative care has been tried, then surgery is recommended.

How is this procedure different?

In classic heel spur surgery, a large open incision is made to severe the tight ligament in the arch known as the plantar fascia and to remove the bone spur which has formed within the fascia. Studies have proven that the actual bone spur is a result of chronic inflammation when the fascia attaches to the heel bone. The heel spur is formed over a long period of time because of constant pulling. This problem usually produces inflammation, pain and inability to bear weight on the heel comfortably. The inflammation stimulates spur formation. THE SPUR IS A SYMPTOM OF THE INFLAMMATION AND NOT THE CAUSE OF HEEL PAIN. In Instep Plantar Fasciotomy it is not necessary to remove the heel spur in order to resolve the pain.

What are the expected results of this procedure?

Most patients return to their regular shoes in 3-5 days. Most return to work after the first week, and return to normal activity by the end of the third week. Everyone heals slightly differently. Other factors such as age, weight and occupation can contribute to healing time.

What are the Risks and Complications of this procedure?

Fortunately, there are few complications that are relatively minor and usually resolved with careful follow-up. As with all surgery,no procedure is risk free, and there is no guarantee as to the success of this procedure. The most common risks inherent to this procedure include delayed healing with aching at the surgical site or instep, infection and a possibility of a small area of numbness at the incision site. These complications are extremely rare.

Will my insurance cover this procedure?

You should have benefits for this procedure if you have surgical coverage. You may be responsible for a portion of the surgical fees including insurance deductibles and co-pays.

Why Us?

Dr Elaine Shapiro is a Board Certified foot surgeon who began practicing in Tucson in 1980 after successfully completing a surgical residency in Chicago, Illinois. In 1991 she became a fellow of the American College of Foot and Ankle Surgeons and a Diplomate of the American Board of Podiatric Surgeons. She has since been asked to be an examiner for the certification exam. She is one of the few surgeons certified in both laser and Endoscopic surgery, and she has been called upon to observe other surgeons in the Tucson area.

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