I recently found out from an x-ray that I have a large heel spur in the center of my left heel. I've been resting for three weeks but I'd really like to get back into training as I'm doing my second half-marathon in September.

My orthopedist gave me a set of gel heel cups to wear in my shoes to help with the pain. Besides that, what else can I be doing to get back to running again? Also, would going to mid-front strike aiding shoe like a Newton help alleviate pressure on my heels?

Kim

Dear Kim,

I do not have your x-ray in front of me so I am going to guess that the “spur” is located at the origin of the plantar fascia on the anterior-inferior portion of the calcaneus (heel bone). The spur is the result of tugging on your plantar fascia and a marker of stress on the soft tissue (calcification is “healing gone wrong”). The spur is not the cause of your pain, but rather a part of plantar fasciitis.

Plantar fasciitis is difficult to heal and there are many treatment strategies, none really proven better than the others. Here is my general approach:

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  • Reduce the pain by icing with a frozen water bottle (bottle on the floor and roll the painful part of the foot back and forth across the bottle – gradually increasing the pressure)
  • Do full heel drops off a stair with slow up and down, allowing the calf and fascia to stretch at the lower end of the movement
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  • Consider an injection with autologous blood or cortisone (painful, not proven)
  • Resume running as tolerated – every other day to start

I would also recommend a kinetic chain evaluation of the foot, ankle, lower extremities, pelvis, and back. The heel may be the victim of a distant culprit in the pelvis. Some runners have moved to shorter stride length to take some pressure or force off the plantar fascia mechanism.

If the heel cups help, it is fine to use them. The Newton shoe line seems to be promoting a “midfoot” style of running, which may be similar to changing to a shorter stride length. Changing to a shorter stride length does require a lower and narrower heel in the shoe.  It may take several weeks of “active” healing to get back to running.

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Cheers,

Bill

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