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This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2017. For the original video go to https://www.youtube.com/watch?v=S30nHV5A5Os&t=617s.
Bob: Today, Brad, we're going to talk about the big lie about heel spurs, heel pain, and plantar fasciitis. This is kind of a myth that's going around and it's being perpetuated by a lot of websites, even.
Brad: Sure. You're right, and it gets people, their anxiety too high and makes the diagnoses worse than what they really are.
Bob: So what are we talking about? Now a heel spur actually forms, if you look at the bottom of the foot right on the heel. You have the fascia, that's the tough band that runs from the heel to the toes. Well, underneath the fascia are some small muscles that help flex the toes.
Brad: Right. They curl the toes.
Bob: Yeah. They put a force on the bone and they're pulling on the bone. If those muscles are tight, they're going to be pulling on the bone for years and putting the stress on it. And what does bone do when it reacts to a force?
Brad: It calcifies.
Bob: It calcifies and pulls out. So here we have the muscles attached from the heel to the toes.
Brad: By the way, this is Bob's rendition or artistry of a foot.
Bob: It's terrible.
Brad: So those are toes, and this is supposed to be some big fat, calcaneus, I guess.
Bob: Yeah. Here we have the muscles in the green here, and they're pulling on this bone, and after a while, it actually calcifies and through Wolf's Law creates more bone and it creates a bone spur that sticks out.
Brad: And they are a little pointy.
Bob: They're a little pointy.
Brad: Yeah. That's why they got the name bone spurs. So are they causing a problem, Bob?
Bob: That's the big dilemma here. That's the big myth, that they cause you pain. This is what happens, Brad, you go in and you're having pain in your heel and you've had it for quite a while and you're going to the doctor and finally he decides to take an x-ray. And lo and behold, he sees a bone spur. So he goes "that's what's causing your pain?" Well, it's not. Generally, in very rare cases it might.
Brad: Sure.
Bob: If you can actually feel it, they said, if you can feel it below the surface, it might be giving you pain. They said one out of 20 people who have heel spurs has pain.
Brad: And they've done studies on this where they take people with zero symptoms, X-ray them and find a certain percentage of bone spurs, but there are no symptoms. They're living a normal life.
Bob: In one study I saw, 15% of the population has bone spurs, and they have no pain. So, what's causing your pain in most instances is the plantar fascia which is down below. So, you treat the plantar fascia and the pain goes away.
Brad: So the plantar fascia is a wide ligamentous material that runs along the bottom of your foot.
Bob: Right. Let's go ahead and show it on you, Brad.
Brad: So this red spot here. That's a common hot spot for the plantar fascia.
Bob: That's generally where you're going to feel the pain with plantar fasciitis. And the fascia runs along the bottom of the foot there.
Brad: Yeah, it's that wide band and it goes from the heel all the way up.
Bob: Up into the toes.
Brad: Right.
Bob: It does extend up, you know when you stretch the toes, you are stretching the fascia. I want to show that a little later on.
Brad: Right.
Bob: But let's say that's really not where your pain is. Let's talk about some of the other things that could be causing your heel pain.
Brad: Sure, you bet.
Bob: First off, let me say, Brad if you are having heel pain in both heels, I would probably have you get checked out by a doctor. Especially if it's both heels and other joints, it could be something more systemic. I don't want to throw out scary terms, but it could be rheumatoid arthritis, lupus, or some of these other things.
Brad: You're saying typically you don't have this problem in both feet. It happens in one. It's kind of like sciatic, it's usually one leg affected.
Bob: Right. Although it can. I had the start of it in both feet because both of my shoes were bad.
Brad: I can just imagine. I suppose that was in your college days.
Bob: Well, no, it was just from running too much.
Brad: Last year?
Bob: Yeah, I was wearing it out.
Brad: Sure.
Bob: Which by the way, they find more bone spurs in people that are older of course, because it takes a long time to create that bone spur.
Brad: Right. It takes a while for that calcification.
Bob: So one of the first tests I want you to do, is I want you to do the squeeze test.
Where you just go up there you squeeze the calcaneus bone there.
Brad: Okay.
Bob: You're going to squeeze it. And if there's any pain there, then you should go and get x-rays, because maybe you have a fracture there.
Brad: Okay.
Bob: You know if you're osteoporotic or if you run a lot you could have a stress fracture there.
Brad: So you're squeezing the bone itself.
Bob: Yep. You're squeezing the bone itself.
Brad: Pretty aggressively.
Bob: Yep. Yep. You want to see it. There shouldn't be any pain. Do you have any pain right now?
Brad: Absolutely not.
Bob: No. No.
Brad: I'm not that strong.
Bob: So yeah, that might be part of it. (chuckles) All right. Now let's palpate another spot, Brad. You've already got it drawn in there, the red spot there. You have the posterior tibial tendon that comes around through here and attaches to the navicular bone. So if your heel pain is actually coming from right around in here, you are more likely to have posterior tibial tendonitis.
Brad: Sure.
Bob: And not plantar fasciitis and not a heel spur.
Brad: So actually, the bone right above it acts as a little pulley system and it goes around and the muscle is up in the calf more.
Bob: Yep, it pulls up and turns the foot in and all that.
Brad: Yeah, it makes you invert.
Bob: The other spot, if your tenderness is in the back of the ankle and this might even go down into the heel. Then you may have more Achilles tendonitis.
Brad: Right. You've got that big Achilles tendon there. That's an amazing tendon.
It really does a lot of work so it can easily get injured.
Bob: And then the last one, Brad. Yes. So you could have it on the outside of your foot, again, going around the ankle bone. And that would be peroneal tendonitis.
Bob: All right. So Brad, again, I'm going to assume most of you are going to have plantar fasciitis. That's the one that's very, very common.
Brad: Right.
Bob: Let's just show you three things you can do for it, Brad.
Brad: Sure.
Bob: You know, we don't want to have you leave here with us just giving you this big myth and then finding out we didn't give you any answers for it. So, one thing you want to make sure of, Brad is, that when you get up in the mornings you're putting your shoes on before you get out of bed.
Brad: Right.
Bob: And that usually is a symptom, isn't it, Brad? That when you get up after you've been sitting for a while or in the morning, it really hurts.
Brad: Right. Should we tell them the reason? It's because if you sleep all night, your feet are typically in a relaxed position, or plantar flexed. These tissues tighten up overnight, and they're already sore because they were sore the day before, and then you put a quick stretch on them with all that weight and all those tender tissues wake them up really quick.
Bob: Then they break open again. That's scar tissue and you break it open again.
Brad: Well, it'd be like if you had a cut on your knuckle and bent it hard, and you just split it.
Bob: Yeah, exactly. So, before you even get out of bed, the thing I like to have people do is to actually stretch those toes. And you're stretching that plantar fascia. Just grab the forefoot here and pull. And this is so easy to do in bed before you even get out.
Brad: Right. You're going to do it slowly, you'll know. Your body will tell you.
Bob: Yep. Just go ahead and give it a stretch. And I would like to see you doing this stretch throughout the day like if you're sitting in a chair and you've been sitting for a while, and before you get up again and you get that sharp pain, go ahead and give it a stretch.
Brad: Sure.
Bob: Before you even get up. Take your shoe off and have people talk about you in the office. That's always fun.
Brad: Maybe you can get someone to come over and do it for you.
Bob: Oh, I bet you that's going to be easy to do. Yeah. All right. The next thing you want to try, Brad, is we had a lot of people that have had luck with the splint. The night splint.
Brad: And there are quite a few different makes and models of these, but they have the same basic concept. Oftentimes they're Velcro.
Bob: This is the thing that, my wife was doing all the other things you're supposed to do, she was icing and stretching. This is the one that healed it quickly.
Brad: Sure.
Bob: I mean, I was shocked. It was within two nights and she was already back to walking and then by a week she was back to running.
Brad: So in her case, that was a key part of the healing.
Bob: I know I'm only giving one example, but the studies have shown too, that this combined with the other stuff often really does help. So show what it does, Brad.
Brad: Oftentimes they're adjustable. So see, my foot can plantar flex or go down, but if you pull it up, then that pulls it into that neutral position.
Bob: Yeah. You really have to watch it. I mean, you can't stretch it too much. She said there were a couple of times she woke up in the middle of the night and had to release it because it was too much.
Brad: Right.
Bob: So. And the last thing I'm going to show you, Brad, is a taping one. And this is the thing, you try it and if it works great, if it doesn't work, don't do it. But you just get some tape, athletic tape that doesn't stretch much. So what you're going to do is, this is the one if we're going to do the left foot here, you're going to put it underneath the foot, underneath the heel, and you're going to bring it up and around. This should be a longer piece. It should go all the way around, I didn't measure this before. But what this is doing is called externally rotating the heel. So you're going to pull up on it like this and then pull it across.
Brad: You tape up to there?
Bob: I would tape even beyond it.
Brad: Okay.
Bob: I would go all the way around even.
Brad: I've done it up to this area already.
Bob: Oh really?
Brad: Yeah.
Bob: That would do it too.
Brad: Yeah. Either way, it pulls it this way, but then I always put some tape around to hold the end.
Bob: Right, to hold the tape in place. If you even do it my way, I would double tape it by every means.
Brad: You could double tape by combining ours and really have some support over there.
Bob: Yeah. Either way, you're really trying to externally turn that heel.
Brad: And you know this will work because as soon as you walk the pain will go from an eight over 10 down to half of that.
Bob: I think when you first step, it's going to feel awkward because you have to let the tape stretch out a little bit.
Brad: Yeah, you'll feel the tape pulling.
Brad: Just pulling your skin.
Bob: Right, if it's going to help, it's going to help right away, it's going to feel better.
Brad: Right.
Bob: And if it does, you can tape every day.
Brad: That is fun as a therapist when you put that tape on and they get up and walk around and they put a smile on their face and say, "Oh, I can't remember walking like this."
Bob: Right. Without pain. So, thanks, everybody.
Brad: Oh yeah, it's time to go.
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